COLUMBIA  LIBRARIES  OFFSITE 

HEALTH  SCIENCES  STANDARD 


HX641 22557 
RC309.A2  B73  a  directory  of  insti 


RECAP 


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i 


A  DIRECTORY 

OF 

INSTITUTIONS  AND  SOCIETIES 

DEALING  WITH 

TUBERCULOSIS 

IN  THE  UNITED  STATES  AND  CANADA 


COMPILED  BY  LILIAN  BRANDT 


PUBLISHED    BY 

THE  COMMITTEE.  ON  THE  PREVENTION  OF  TUBERCULOSIS  OF  THE 
CHARITY  ORGANIZATION  SOCIETY  OF  THE  CITY  OF  NEW  YORK 

AND 

THE  NATIONAL   ASSOCIATION    FOR  THE    STUDY  AND  PREVENTION 
OF  TUBERCULOSIS 

1904 


Copyright,  1904, 

BY 

THE   CHARITY  ORGANIZATION   SOCIETY  OF   THE  CITY  OF  NEW  YORK 


Press  of  the 

Evening  Post  Job  Printing  House, 

Sew  York. 


Lilian  Brandt,  Statistician 


Paul  Kennaday,  Secretary, 

105  East  22d  Street 


THE    COMMITTEE    ON    THE    PREVENTION 
TUBERCULOSIS 

OF 

THE  CHARITY  ORGANIZATION  SOCIETY 

OF    THE    CITY    OF   NEW     YORK 


OF 


Charles  F.  Cox,  Chairman 
Otto  T.  Bannard 
Hermann  M.  Biggs,  M.D. 
David  Blaustein 
Herbert  S.  Brown 
Joseph  D.  Bryant,  M.D. 
Thos.  C.  T.  Crain 
Thos.  Darlington,  M:D. 
Robert  W.  de  Forest 
Edward  T.  Devine 
Homer  Folks 
J.  H.  Huddleston,  M.D. 
Robert  Hunter 
A.  Jacobi,  M.D. 
Walter  B.  James,  M.D. 
E.  G.Janeway,  M.D. 
A.  B.  Jennings 
S.  A.  Knopf,  M.D. 


Alexander  Lambert,  M.D. 
Ernst  J.  Lederle 
Frederic  S.  Lee,  M.D. 
Henry  M.  Leipziger 
Egbert  Le  Fevre,  M.D. 
Henry  P.  Loorais,  M.D. 
James  Alexander  Miller,  M.  D. 
Mrs.  James  E.  Newcomb 
Eugene  A.  Philbin 
Ernest  Poole 

T.  Mitchell  Prudden,  M.D. 
Andrew  H.  Smith,    VI. D. 
W.  G.  Thompson,  M.  D. 
E.  L.  Trudeau,  M.D. 
James  H.  Tully 

Frederick  L.  Wachenheim,  M.D. 
Lillian  D.  Wald 


THE   NATIONAL   ASSOCIATION    FOR  THE   STUDY  AND 
PREVENTION  OF  TUBERCULOSIS 


OFFICERS 


President:  Edward  L.  Trudeau,  M.D. 
Vice-Presidents:  William  Osier,  M.D. 

Hermann  M.  Biggs,  M.D. 


Treasurer:  Gen.  George  M.  Sternberg,  M.D. 
Secretary:  Henry  Barton  Jacobs,  M.D. 


BOARD   OF   DIRECTORS 


Howards.  Anders,  M.D. 
Robert  H.  Babcock,  M  D. 
Hermann  M.  Biggs,  M.D. 
Vincent  Y.  Bowditch,  M.D. 
Henry  M.  Bracken,  M.D. 
Norman  Bridge,  M.D. 
Maj.  George  E.  Bushnell,  M.D. 
Edward  T.  Devine 
Lawrence  F.  Flick,  M.D. 
John  P.  C.  Foster,  M.D. 
John  S.  Fulton,  M.D. 
Frederick  L.  Hoffman 
John  N    Hurty,  M.D. 
Henry  Barton  Jacobs,  M.D. 
Arnold  C.  Klebs,  M.D. 

Office:  105  East  22d  Street,  New  York  City. 


S.  A.  Knopf,  M.D. 
Charles  L.  Minor,  M.D. 
William  Osier,  M.D. 
Edward  O.  Otis,  M.D. 
Leonard  Pearson.  M.D. 
William  Porter,  M.D. 
Charles  O.  Probst,  M.D. 
Mazyck  P.  Ravenel,  M.D. 
S.  Edwin  Solly,  M.D. 
Matthew  M.  Smith,  M  D. 
Gen.  George  M.  Sternberg,  M.D. 
Edward  L.  Trudeau,  M.D. 
Victor  C.  Vaushan,  M.D. 
William  H.  Welch,  M.D. 
Gen.  Walter  Wyman,  M.D. 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/directoryofinstiOObran 


CONTENTS 

PAGE 

Map  showing-  the  location  of  all  institutions vi 

Introduction vii 

Part  I.— SanatoriuiMS,  Hospitals  and  Camps. 

I. — Essential  Features  in  Sanatoriums  for  Incipient  Cases.    Edward 

L.  Trudeau,  M.D i 

II. — Essential  Features  in  Hospitals  for  Advanced  Cases.  Law- 
rence F.  Flick,  M.D 7 

III. — Institutions  in  the  United  States  and  Canada 13 

Part  II.— Special  Dispensaries. 

I. — The  Function  of  Special  Dispensaries  and  Important  Features 

in  their  Organization.     Edward  O.  Otis,  M.D 147 

II. — Special  Dispensaries  in  the  United  States 153 

Part  III.— The  Tuberculous  Insane. 

I. — Tent  Treatment  for  Tuberculous    Insane.     A.  E.  Macdonald, 

M.D 169 

II. — Hospitals   for  the  Insane  in  which  Special  Provision  is  made 

for  Consumptives 181 

Part  IV. — Tuberculous  Prisoners. 

I. — Prevention  and  Treatment  of  Tuberculosis  in  Penal  Institu- 
tions.    J.  B.  Ransom,  M.D 191 

II. — Penal  Institutions  in  which  Special  Provision  is  made  for  Con- 
sumptives         201 

Part  V.— Municipal   Control  of  Tuberculosis. 

I. — Essential  Features  in  a  Municipal  System  for  the  Control  of  Tu- 
berculosis,    Hermann  M.  Biggs,  M.D 207 

II. —  Summary  of  Existing  Measures  in  the  Principal  Cities  of  the 

United  States.     Lilian  Brandt 217 

Part  VI. — Associations   for  the  Prevention  of 

Tuberculosis  :  Societies,  Committees, 

State  Commissions. 

I. — The  Organization  and  Function  of  Associations  for  the  Pre- 
vention of  Tuberculosis.     Edward  T.  Devine 223 

II.— Associations  in  the  United  States  and  Canada 229 

Index  to  Sanatoriums,  Hospitals  and  Camps,  and  Summary 257 


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INTRODUCTION 

This  Directory  has  been  prepared  with  two  objects  in  view. 
It  is  designed,  first,  to  serve  as  a  guide  to  the  physicians  and 
friends  of  consumptives,  whether  poor  or  well-to-do,  by  furnish- 
ing accurate  information  in  regard  to  existing  institutions.  At 
the  same  time  an  attempt  has  been  made  to  present  a  bird's-eye 
view  of  all  the  organized  work  that  is  being  done  in  the  United 
States  and  Canada  for  the  cure  and  prevention  of  tuberculosis. 

While  the  inclusion  of  an  institution  in  this  volume  is  in  no 
sense  to  be  taken  as  a  recommendation  of  it,  by  either  the  New 
York  Committee  or  the  National  Association,  still,  on  the  other 
hand,  the  attempt  has  been  made  to  exclude  all  sanatoriums  of 
an  undesirable  character :  one,  for  instance,  has  been  dropped 
from  the  list  because  it  advertises  a  new  specialty  every  few 
months,  although  just  at  present  the  specialty  is  tuberculosis; 
another,  because  the  m.ost  prominent  feature  of  the  treatment 
provided  is  the  injection  of  a  serum  of  secret  manufacture; 
another,  because  it  has  displayed  such  zeal  and  persistence  in 
advertising  its  superlative  excellences  as  to  remove  any  possi- 
bility of  confidence.  Several  others,  it  should  be  added,  with 
which  some  correspondence  has  been  had,  have  been  excluded 
for  no  such  reason,  but  merely  because,  while  they  do  not  refuse 
to  admit  consumptives,  they  make  no  special  provision  for  the 
treatment  of  tuberculosis,  and  have  an  insignificant  number  of 
such  cases  among  their  patients.  Boarding  houses  and  hotels 
without  medical  supervision  or  sanatorium  regulations  have  not 
been  included.  A  reliable  list  of  such  as  are  open  to  consump- 
tives and  can  be  recommended  by  a  physician  would  be  most 
useful. 

The  introductory  chapters  in  each  section  furnish  a  criterion 
for  judging  existing  institutions  and  will  in  many  particulars 
offer  a  guide  to  persons  who  are  planning  new  ones.  In  regard 
to  each  institution  the  aim  has  been  to  give  facts  which  will  en- 
able the  physician  to  form  a  just  estimate  of  it  and  which  will 
give  the  patient  and  his  friends  some  idea  of  its  character. 

In  this  connection  it  seems  desirable  to  repeat  the  warning, 
which  cannot  be   sounded  too   frequently  or  too  emphatically, 


INTRODUCTION 

against  leaving  home  for  any  place  without  counting  the  cost. 
From  California,  Colorado,  New  Mexico,  Arizona,  and  the 
Carolinas,  come  protests  against  the  barbarity  of  physicians  who 
send  patients  in  an  advanced  stage  of  consumption  far  from 
home  and  friends,  and  even  from  medical  advice,  with  insuf- 
ficient means  to  supply  the  necessaries  of  life.  There  is  no  cli- 
mate which  will  avail  to  cure  consumption  if  the  other  elements 
in  the  treatment  are  privation,  worry,  and  homesickness.  For 
a  consumptive  in  any  stage  of  the  disease  to  go  to  a  health  resort 
with  the  idea  of  supporting  himself  while  he  gets  well  is  folly, 
if  not  madness.  There  is  always,  at  such  places,  an  excessive 
supply  of  the  kind  of  labor  he  can  offer,  and  wages  are  pro- 
portionately low.  The  cost  of  living,  on  the  other  hand,  is  apt 
to  be  much  higher  than  the  average.  Furthermore,  it  is  neces- 
sary that  exercise,  even  in  the  earliest  stages  of  the  disease, 
should  be  taken  under  the  direction  of  a  physician.  It  is  use- 
less, in  brief,  to  go  to  the  most  favorable  climate  unless  one  has 
the  means  to  meet  a  year's  expenses,  including  a  reserve  for 
emergencies. 

Hiow  far  the  second  object  of  the  Directory  has  been  attained 
it  is  difficult  to  judge.  It  is  believed  that  the  list  of  institutions 
exclusively  or  chiefly  for  the  treatment  of  tuberculosis,  and  the 
list  of  associations  for  the  prevention  of  the  disease,  are  practi- 
cally complete.  There  may  be,  however — and  it  is  to  be  hoped 
that  there  are — many  omissions  of  almshouses,  hospitals  for  the 
insane,  and  prisons  and  reformatories,  in  which  consumptives 
are  segregated  and  given  special  care.  No  attempt  has  been 
made  to  show  what  is  done  by  charitable  societies  in  caring  for 
poor  consumptives  in  their  homes,  because,  although  the  work 
itself  is  extremely  important,  an  account  of  the  variations  in 
method  would  be  somewhat  outside  the  scope  of  the  present 
volume  and  a  complete  inventory  would  include  practically  all 
the  relief  giving  societies  in  the  country. 

The  United  Hebrew  Charities  of  New  York  City  may  be 
cited  as  a  conspicuous  example  of  a  society  which  has  for  sev- 
eral years  been  devoting  special  attention  to  the  tuberculosis 
problem  among  the  families  under  its  care.  All  of  the  families 
in  which  consumption  is  the  main  problem  are  placed  under  the 
care  of  a  special  committee.  The  work  of  this  committee  begins 
with  a  careful  medical  examination,  on  the  results  of  which 
subsequent  action  is  determined ;    treatment  in  a  sanatorium  is 


INTRODUCTION 

provided,  when  this  is  possible ;  when  the  patient  is  obHged  to 
remain  at  home  desirable  medical  treatment  is  supplied  and 
necessary  food ;  suitable  work  is  secured  for  the  improved  con- 
sumptive, frequentlv  in  the  suburbs  or  in  country  towns ;  trans- 
portation is  provided  when  a  change  of  climate  is  advised ;  and 
in  all  cases  friendly  visiting  and  instruction  of  the  consumptive 
and  his  family  are  prominent  features  of  the  treatment. 

Much  can  be  done  for  consumptives  wdio  cannot  or  will  not 
leave  home.  For  those  in  the  early  stages  dispensary  treatment, 
accompanied  by  proper  living,  may  effect  a  cure,  and  sometimes 
it  is  not  even  necessary  that  the  patient  should  stop  working. 
Many  of  those  in  whom  the  disease  is  farther  advanced  are 
unwilling  to  leave  home,  and  when  there  is  little  hope  of  recov- 
ery there  is  no  reason  w^hy  they  should  be  forced  to  do  so,  unless 
they  are  a  menace  to  those  about  them.  In  all  kinds  of  cases 
good  results  have  been  secured  at  home  by  providing  suitable 
medical  advice  and  necessary  food  and  carefully  supervising  the 
family  life.  It  may  not  be  possible,  in  most  instances,  on  ac- 
count of  the  advanced  stage  already  reached  by  the  consumptive 
before  the  family  comes  under  the  care  of  the  society,  to  effect 
a  permanent  cure,  but  it  is  always  possible  to  prevent  the  patient 
from  being  a  source  of  danger  to  others  and  to  teach  his  family 
what  they  should  know  for  their  own  protection  in  the  future. 

To  point  out  the  conspicuously  weak  spots  in  what  the 
French  would  call  our  "armament  against  tuberculosis,"  would 
be  practically  to  enumerate  the  different  parts  of  the  armament. 
For  there  is  no  class  of  institutions,  wdth  the  possible  exception 
of  sanatoriums  for  the  well-to-do,  of  which  there  is  as  yet  any- 
thing approaching  a  sufficient  number.  More  than  a  hundred 
thousand  deaths  are  caused  by  consumption  each  year  in  the 
United  States.  The  total  number  of  beds  for  consumptives, 
in  all  kinds  of  institutions,  is  less  than  eight  thousand,  and 
almost  one-third  of  them  are  in  the  state  of  New  York.  There 
is  imperative  need  of  free  sanatoriums  for  early  cases  and  of 
sanatoriums  for  persons  who  are  able  to  pay  five  or  six  dollars 
a  w^eek.  Nor  is  it  desirable  that  these  should  be  massed  in  the 
Adirondacks,  Colorado,  and  the  southwest.  They  should  be 
distributed  over  the  country.  In  Massachusetts  and  New 
York,  state  sanatoriums  are  now  in  operation ;  the  Rhode  Island 
buildings  are  completed  and  will  be  occupied  in  1905 ;  New 
Jersey    has    secured   a    site   and    has    appropriated    a    sufficient 


INTRODUCTION 

amount  to  erect  and  equip  buildings ;  an  initial  appropria- 
tion has  been  made  in  Minnesota  and  in  Ohio;  and  in 
sixteen  other  states  more  or  less  fruitful  efforts  have  been 
made.  What  has  been  done  is  only  a  beginning.  Each  state 
should  have  its  state  sanatorium  and  each  city  of  considerable 
size  should  provide  its  own  municipal  institution.  There  is 
need  also  of  industrial  colonies  where  persons  in  whom  the 
disease  has  been  arrested  could  be  employed  in  light  outdoor 
work,  such  as  horticulture  and  the  keeping  of  poultry,  pigs, 
and  bees,  under  conditions  which  would  prevent  relapse  and 
would  enable  them  to  be  at  least  partly  self-supporting.  There 
should  be  well-equipped  free  dispensaries  in  every  city.  There 
should  be  in  every  city  a  s^^stem  of  control  by  the  department  of 
health  and  a  private  organization  to  instigate  and  supplement 
public  efforts. 

All  these  are  pressing  needs.  But  there  are  several  other 
respects  in  which  the  United  States  is  peculiarly  negligent.  One 
of  these  is  the  care  of  consumptives  in  public  institutions.  With 
an  adequate  sanatorium  and  hospital  system  there  will  be  no 
reason  why  consumptives  should  be  found  in  almshouses. 
Pending  this  solution  of  the  question,  however,  they  should  be 
housed  in  a  separate  wing,  if  there  is  only  one  building  available, 
or  separate  wards,  or  in  tents.  The  extension  of  sanatorium 
provision  will  not  solve  the  problem  of  the  consumptive  in  hos- 
pitals for  the  insane  and  in  correctional  institutions.  It  is  of 
the  utmost  importance  to  the  welfare  of  the  public  that  this 
question  should  receive  intelligent  consideration.  There  is  the 
less  excuse  for  neglect  in  this  line  of  work  for  the  control  of 
tuberculosis  because  experience  has  already  demonstrated  that 
favorable  results  can  be  obtained  from  comparatively  slight 
expenditures. 

Another  glaring  deficiency  in  the  American  armament  is  in 
provision  for  advanced  cases.  Houses  of  rest  are  urgently  re- 
quired, where  patients  who  are  not  suitable  candidates  for  en- 
trance to  sanatoriums  for  early  cases  and  who  cannot  be  cared 
for  properly  in  their  homes  can  be  received  and  made  comforta- 
ble in  their  last  months.  Ultimately,  with  the  development  of 
facilities  for  preventing  tuberculosis  and  for  curing  it  in  its  in- 
ception, the  need  for  this  class  of  institutions  will  be  practically 
eliminated ;  but  for  some  time  to  come  they  will  be  essential. 

A  third  respect  in  which  the  United  States  is  especially  negli- 


INTRODUCTION 

gent  is  in  its  provision  for  children  suffering  from  non-pulmon- 
ary tuberculosis.  England  has  a  large  hospital  for  such  cases  at 
Margate  and  in  France  there  are  seaside  hospitals  for  them  with 
an  aggregate  capacity  of  four  thousand  beds.  The  only  attempt 
to  provide  seaside  treatment  in  America  is  the  experimental 
camp  of  the  New  York  Association  for  Improving  the  Condition 
of  the  Poor.  At  the  Convalescent  Home  of  the  Children's  Hos- 
pital of  Boston  the  open-air  treatment  in  the  country  has  been 
inaugurated ;  and  at  Loomis  and  Stony  Wold  Sanatoriums  and 
Seton  Hospital,  in  New  York  State,  special  provision  is  made  for 
children.  But  these  are  the  only  efforts  of  the  kind  that  have 
been  discovered. 

There  are  many  signs  that  interest  in  this  work  of  control- 
ling and  eradicating  tuberculosis  is  only  in  the  incipient  stage,  if 
a  technical  phrase  may  be  used,  and  the  indications  are  that  it  is 
rapidly  developing.  There  is  every  reason  to  hope  that  the  sec- 
ond edition  of  the  Directory  will  be  twice  the  size  of  this  volume. 
It  may  not  be  out  of  place  to  express  another  hope,  for  which 
there  is  also  a  basis,  that  in  the  second  edition  it  will  not  be  neces- 
sary to  vary  the  spelling  of  the  word  "sanatorium." 

It  is  intended  to  publish  revised  editions  at  whatever  inter- 
vals may  be  demanded  by  the  progress  made.  With  this  in 
view  all  readers  are  asked  to  send  corrections  of  the  material 
included  in  this  issue,  information  in  regard  to  new  organiza- 
tions of  any  sort,  and  suggestions  for  increasing  the  value  of 
the  Directory  as  a  book  of  reference.  L.  B, 


Paet  I 

SANATORIUMS,  HOSPITALS  AND  CAAIPS 


L— ESSENTIAL  FEATURES  IN  SANATORIUMS 

FOR  INCIPIENT  CASES 

EDWARD  L.  TRUDEAU,  M.  D. 

PRESIDENT  OF  THE  ADIRONDACK  COTTAGE  SANITARIUM 


SANATORIUMS   FOR  THE  TREATMENT   OF 
INCIPIENT   TUBERCULOSIS 

Sanatoriums  may  be  broadly  divided  into  two  classes :  those 
which  aim  at  the  restoration  of  patients,  and  those  which  are 
merely  designed  on  humanitarian  principles  to  care  for  hopeless 
cases,  and  to  prevent  them  from  infecting  others.  Formerly 
a  consumptives'  hospital  was  regarded  simply  as  an  asylum  for 
hopeless  cases,  and  such  institutions,  for  far  advanced  cases, 
are  as  much  needed  as  ever  on  humanitarian  grounds,  and  to 
prevent  such  cases  from  infecting  those  about  them.  The 
modern  sanatorium,  however,  represents  an  attempt  to  cure, 
and  keeps  this  end  in  view  in  limiting  admission  to  favorable 
and  early  cases.  It  recognizes  that  what  success  is  to  be  obtained 
in  treating  its  patients  is  dependent  on  an  early  diagnosis,  and 
on  a  thorough  application  of  its  methods  of  treatment  before 
the  general  health  has  become  much  impaired  and  the  organic 
damage  extensive. 

The  first  requisite,  therefore,  for  admission  to  these  institu- 
tions is  that  the  case  should  be  a  truly  incipient  one,  or  at  least 
that  there  should  be  a  fair  prospect  of  arresting  the  disease. 
The  earlier  the  tuberculosis  is  detected  and  the  patient  informed 
of  the  true  nature  of  his  malady,  the  better  will  be  the  chance 
of  cure,  for  if  he  be  deceived  as  to  the  serious  meaning  of  his 
slight  symptoms  he  is  not  likely  to  make  willingly  the  necessary 
sacrifice  of  time  and  money,  and  would  lose  the  opportunity  for 
restoration.  About  seventy-five  per  cent  of  applicants  are  re- 
fused at  the  sanatoriums  for  the  treatment  of  incipient  tuberculo- 
sis because  their  cases  are  considered  too  far  advanced,  though 
some  institutions  take  a  fair  proportion  of  advanced  cases. 

The  modern  sanatorium  represents  the  most  favorable  en- 
vironment attainable  for  the  consumptive,  and  depends  for  its 
efficiency  on  the  following  factors :  a  good  climate,  buildings 
specially  adapted  for  this  method  of  treatment  and  for  protecting 
its  inmates  from  infection,  facilities  for  living  an  outdoor  life 
in  all  kinds  of  weather,  good  food,  and  strict  medical  discipline 


SAXATORIUMS    FOR    EARLY    CASES 

SO  far  as  rest,  exercise,  and  the  details  of  the  daily  life  are 
concerned. 

Climate  of  late  years  has  not  been  considered  so  essential  as 
formerly.  It  has  been  shown  undoubtedly  that  excellent  results 
are  obtained  by  the  open-air  method  in  sanatoriums  situated 
in  climates  laying  no  special  claim  to  any  favorable  influence  on 
tuberculosis,  but  it  cannot  be  denied  that  a  good  climate  must  be 
a  factor  of  considerable  value  in  securing  the  most  favorable 
environment  attainable  for  the  consumptive,  and  that  climate 
should  always  be  utilized  when  available. 

The  situation  of  the  institution,  so  far  as  exposure,  drainage, 
water  supply,  shelter  from  prevailing  winds,  and  freedom  from 
dust-laden  air,  are  concerned,  is  universally  recognized  to  be 
of  the  utmost  importance,  as  well  as  the  construction  of  the 
buildings. 

Either  the  tent,  the  cottage,  or  the  pavilion  plan  is  generally 
adopted  by  the  most  successful  institutions,  as  tending  to 
segregate  patients  and  to  afford  them  the  best  conditions  of 
sunlight,  ventilation,  and  convenience  in  living  the  outdoor  life 
which  is  considered  essential  to  cure. 

Special  care  of  the  expectoration,  scrupulous  cleanliness,  sun- 
light, abundant  air  space  and  ventilation,  are  relied  upon  and 
have  been  proved  thoroughly  efficacious  to  protect  patients  from 
any  evil  effects  of  aggregation.  There  is  much  less  chance  for 
a  susceptible  individual  to  become  infected  in  a  well-planned 
and  well-directed  sanatorium  than  anywhere  in  the  ordinary 
walks  of  life.  Facilities  that  enable  the  patient  to  sit  out  of 
doors  in  any  kind  of  weather,  and  to  sleep  out  of  doors  on 
sheltered  verandas  at  night  when  ordered  by  the  physician,  are 
among  the  important  features  of  the  modern  sanatorium.  An 
infirmary  should  also  always  be  available,  where  the  acute  re- 
lapses and  complications  of  the  disease  can  be  treated  by  keep- 
ing the  patient  in  bed,  often  for  weeks  at  a  time,  with  good 
nursing,  and  yet  not  interfere  with  his  open-air  treatment. 

Ever\fthing  is  planned  to  encourage  living  out  of  doors  with 
comfort  in  any  kind  of  weather,  and  to  render  this  in  no  way 
irksome.  This  habituation  to  an  out-of-door  life,  and  to  the 
natural  changes  of  temperature,  and  inclemencies  of  weather,  is 
a  potent  factor  in  invigorating  the  patient  and  in  increasing  his 
resistance  to  a  disease  which  is  so  largely  due  to  an  indoor  life 
and  its  evil  consequences. 


SANATORIUMS    FOR.   KARI^Y    CASES 

Cold,  tepid,  or  hot  baths  are  an  important  element  of  the 
treatment,  and  should  be  easily  available  to  every  patient.  The 
quantity  and  quality  of  the  food,  the  intervals  of  rest  and  exer- 
cise, the  occupations  and  amusements  of  the  patients,  are  all 
under  the  control  of  the  physician,  and  discipline  is  the  keynote 
of  success.  The  patient  lives  constantly  under  the  direction  of 
the  physician. 

The  duration  of  the  patient's  treatment  should  be  from  five 
to  six  months  or  more,  as  little  that  is  permanent  in  the  way 
of  cure  can  be  accomplished  in  most  cases  by  a  shorter  stay. 
The  education  the  patient  receives  in  these  institutions  is  of  the 
utmost  value  to  him  in  teaching  him,  as  he  can  learn  nowhere 
else  so  effectually,  how  to  protect  himself  and  others  from 
infection,  and  how  to  live  and  care  for  himself  if  relapses  occur 
after  he  has  left  the  institution. 

E.  L.  Trudi^au. 


II.— ESSENTIAL    FEATURES    IN    HOSPITALS 
FOR    ADVANCED    CASES 

LAWRENCE  F.  FLICK 

DIRECTOR  OF  THE  HENRY  PHIPPS  INSTITUTE 


ESSENTIAL  FEATURES  IN  HOSPITALS  FOR 
ADVANCED    CASES 

The  success  of  the  crusade  against  tuberculosis  which  now  is 
being  preached  and  inaugurated  all  over  the  civilized  world 
will  in  a  great  measure  depend  upon  the  manner  in  which  the 
resources  at  hand  are  put  to  practical  use.  Tuberculosis  is  so 
prevalent,  so  widespread,  and  so  paralyzing  in  its  influence  that 
a  movement  for  its  extermination  necessarily  becomes  a  her- 
culean undertaking.  So  many  things  that  could  be  done  suggest 
themselves  to  one  that  one  hardly  knows  what  ought  to  be  done 
first.  With  limited  resources  it  is  therefore  of  some  importance 
to  inaugurate  first  those  measures  which  promise  the  best  re- 
turns with  the  least  outlay  of  money. 

Of  the  measures  which  may  be  classed  as  of  importance  the 
establishment  of  hospitals  for  advanced  cases  easily  stands  first. 
This  does  not  appear  to  be  so  at  first  blush,  but  proves  to  be  so 
upon  analysis  of  the  various  measures  in  all  their  influences. 

Tuberculosis  is  a  contagious  disease  which  depends  upon 
intimate  contact  for  dissemination  and  which  probably  never  is 
communicated  except  by  intimate  contact.  This  contact,  more- 
over, must  take  place  in  an  enclosure  and  vmder  proper  condi- 
tions. Among  human  beings  the  lower  down  in  the  scale  of 
prosperity  the  better  are  the  conditions  for  implantation,  because 
not  only  are  the  dwellings  in  which  the  poor  live  the  most  ideal 
enclosures  for  the  propagation  of  the  disease,  but  the  poor 
themselves  constitute  the  most  ideal  soil  for  its  implantation  and 
growth. 

We  know  from  clinical  observations,  moreover,  that  the  last 
few  months  of  life  of  a  consumptive  constitute  the  time  when 
seed  for  new  implantations  is  most  generously  given  ofif.  This 
is  the  time,  too,  when  the  person  afflicted,  on  account  of  his 
symptoms,  is  apt  to  house  himself  closely  and  thereby  create 
the  contagious  environment  which  is  most  potent  for  new 
implantations.  Here,  again,  the  lower  in  the  scale  of  prosperity 
the  greater  the  likelihood  that  the  house  occupied  by  the  con- 
sumptive will  be  made  a  contagious  environment  capable  of  giv- 
ing implantations. 

In  the  crusade  against  tuberculosis  the  most  important  work 
is  the  prevention  of  implantations.     When  the  tubercle  bacillus 


H0SPITAI,S     I^OR    ADVANCED     CASElS 

once  has  been  implanted  in  a  person  it  is  a  long  and  difficult 
process  to  get  it  out  of  him.  Even  when  physical  health  has 
been  restored  to  such  a  person  he  may  contain  tubercle  bacilli 
in  his  tissues  and  at  times  give  them  off  as  a  seed  supply  for  new 
implantations.  A  person  who  never  has  had  an  implantation 
of  tuberculosis  is  therefore  in  every  way  better  off  and  is  a  more 
valuable  citizen,  other  things  being  equal,  than  a  person  who 
has  had  tuberculosis,  however  well  the  latter  may  become. 
This,  of  course,  is  entirely  from  the  viewpoint  of  preventive 
medicine. 

If  the  tuberculous  matter  given  off  by  all  tuberculous  subjects 
in  the  world  could  be  sterilized  immediately  when  given  off  no 
new  cases  of  tuberculosis  could  arise,  and  when  all  the  present 
tuberculous  subjects  would  have  died  human  tuberculosis  would 
be  extinct.  Whilst  to  accomplish  this  is  theoretically  possible, 
practically  it  is  impossible.  A  very  considerable  proportion  of 
the  human  race  at  the  present  time  is  tuberculous.  Many  of 
these  people  need  only  to  be  told  what  to  do  to  make  themselves 
harmless  to  others.  Many  more  have  the  disposition  to  do  what 
is  necessary,  but  lack  the  intelligence,  the  knowledge,  or  the 
means.  Some  have  the  intelligence  and  the  means,  but  not  the 
disposition.  Others,  perhaps  a  fcAV  only,  lack  the  intelligence, 
the  means,  and  the  disposition. 

The  health  of  a  community  is  no  more  secure  than  is  the 
sanitary  guard  around  the  humblest  home.  It  is  the  poor  and 
the  lowly  who  serve  the  rich  and.  the  proud,  and  it  is  therefore 
through  the  poor  and  the  lowly  that  disease  is  most  easily  spread. 
A  poor  man  not  only  comes  in  contact  with  those  of  his  own 
class,  but  he  is  intimately  associated  with  people  of  every  class. 
He  necessarily  carries  with  him  the  disease-breeding  environ- 
ment of  his  own  home  wherever  he  goes.  If  he  has  tuber- 
culosis in  his  home  and  preventive  measures  are  not  practiced 
in  that  home,  his  clothing  is  saturated  with  tuberculous  matter 
in  dried  pulverized  form  and  he  is  a  source  of  danger  to  every 
one  with  whom  he  comes  in  contact  intimately  for  a  long  enough 
period  of  time. 

The  danger  to  the  community  from  a  contagious  case  of 
tuberculosis  in  a  poor  family  grows  in  geometrical  progression. 
Under  the  stress  of  poverty  and  deprivation  and  hardship  such 
a  case  will  give  rise  to  new  implantations  in  every  member  of 
that  household  during  the  time  that  the  patient  is  confined  to  the 

10 


HOSPITALS     FOR    ADVANCI^D    CASES 

house,  and  in  a  little  while  there  will  be  a  number  of  walking 
distributors  of  contagion  instead  of  one.  Each  of  these  new 
cases  in  its  turn  becomes  a  propagator  of  a  number  of  cases, 
and  in  this  way  the  disease  is  spread  on. 

The  dying  consumptive  undoubtedly  is  the  most  prolific 
source  of  the  spread  of  contagion.  The  beginning  of  a  compre- 
hensive scheme  for  the  prevention  of  tuberculosis  should  there- 
fore be  with  him.  To  make  him  absolutely  innocuous  in  his 
own  home  is  difficult  and  expensive.  It  means  the  provision  of 
a  skillful  attendant  to  watch  over  him,  ample  bed  linen  for 
change  when  the  bed  linen  has  been  soiled,  and  such  preventive 
measure  supplies  as  spit-boxes  and  napkins.  The  difficulty  of 
keeping  him  sterile  can  only  be  appreciated  by  those  who  have 
tried  it.  The  expense  is  high,  even  in  a  hospital  where  a  num- 
ber of  patients  are  under  the  supervision  of  a  single  attendant. 
Without  an  attendant  it  cannot  be  accomplished.  The  patient 
grows  so  weak  toward  the  last  that  he  can  no  longer  avoid  soil- 
ing his  bed  linen  with  sputum  and  just  in  proportion  as  he  grows 
weak  the  amount  of  broken  down  tissue  which  he  ejects  in- 
creases in  quantity. 

One  of  the  first  things  to  do  then  in  every  community  in  the 
crusade  against  tuberculosis  is  to  establish  wards  or  hospitals 
for  poor  dying  consumptives.  In  the  larger  cities  one  or  more 
special  hospitals  should  be  built  and  equipped.  In  smaller  cities 
and  towns  where  the  size  of  the  population  would  not  warrant 
such  an  expense  a  ward  in  some  general  hospital  may  be  set 
aside  for  this  purpose  Whether  a  ward  be  set  aside  or  a 
hospital  built,  the  equipment  should  be  for  the  treatment  of  the 
patient  along  modern  scientific  lines,  and  not  for  the  mere  main- 
tenance of  dying  people.  Even  the  dying  consumptive  should 
be  given  every  opportunity  for  recovery,  and  when  recovery  is 
no  longer  possible  should  nevertheless  be  made  to  feel  that  he  is 
treated  with  hope  and  not  left  an  outcast  of  human  sympathy. 

There  need  be  no  hesitancy  on  the  score  of  contagion  in  set- 
ling  aside  a  ward  in  a  general  hospital  for  the  treatment  of  con- 
sumptives. The  dying  consumptive  can  be  so  cared  for  and 
watched  over  even  to  his  last  breath  that  he  is  absolutely  harm- 
less to  those  in  his  immediate  environment.  The  contagion  of 
tuberculosis  is  only  in  the  expectoration  or  broken-down 
tissue,  and  this  can  easily  be  sterilized  as  it  comes  from  the 
patient  if  he  is  under  proper  supervision  and  has  good  care. 

11 


HOSPITALS     FOR    ADVANCED     CASES 

Military  discipline  is  necessary  and  the  nurses  and  attendants 
must  be  especially  trained  for  the  work.  Until  the  patient  be- 
comes helpless  in  bed  he  usually  can  be  taught  to  keep  himself 
sterile  and  generally  he  does  so  when  he  is  helped  and  watched 
over.  It  is  only  when  he  becomes  helpless  that  there  is  any 
difficulty.  At  this  time  it  must  be  accomplished  by  the  attend- 
ants altogether  independently  of  him.  The  bed  linen  must  be 
changed  every  time  it  is  soiled,  even  though  it  be  a  half  dozen 
times  a  day.  In  doing  so  it  must  not  be  agitated,  and  it  should 
immediately  be  put  into  a  laundry  bag  and  removed  before  the 
broken-down  tissue  has  thoroughly  dried.  Cleanliness  is  the 
watchword.  Rooms  in  which  dying  consumptives  live  must  be 
scrubbed  daily,  and  everything  in  them  must  be  kept  absolutely 
clean.  With  such  care  there  can  be  no  contagion,  either  to 
people  in  the  rooms  or  to  people  elsewhere  in  the  same  building. 

In  cities  and  towns  where  a  hospital  cannot  be  built  for  dying 
consumptives,  and  where  wards  for  their  maintenance  cannot 
be  obtained,  an  ordinary  house  can  be  turned  into  a  hospital  for 
consumptives  and  can  be  equipped  for  the  best  scientific  care  of 
such  patients  if  only  a  little  common  sense  is  used.  After  all  it 
is  more  the  intelligence  and  devotion  of  attendants  than  it  is 
the  character  of  the  building  which  counts  in  the  prevention 
of  the  disease.  It  is  true  the  maintenance  of  a  consumptive  in  a 
building  which  has  been  adapted  for  his  treatment  is  less  expen- 
sive than  it  is  in  a  building  which  is  improvised  for  such  a  pur- 
pose, but  the  difference  in  cost  is  not  prohibitive. 

The  influence  which  the  care  of  dying  consumptives  in  hospi- 
tals exercises  for  prevention  is  well  illustrated  in  the  reduction 
of  the  death  rate  from  consumption  in  London  during  the  last 
fifty  years.  A  little  over  fifty  years  ago  the  English  people  be- 
gan to  establish  hospitals  for  consumptives  in  London  as  a  mat- 
ter of  humanity.  The  work  met  with  favor  and  the  beds  gradu- 
ally increased  until  they  numbered  thousands.  At  that  time  the 
death  rate  from  consumption  in  London  was  about  the  same  as 
that  in  Paris  and  all  the  large  cities  in  the  world,  namely  about 
four  per  thousand.  No  other  preventive  measure  was  intro- 
duced in  London.  At  the  end  of  fifty  years,  London,  the  largest 
city  in  the  world,  had  the  lowest  death  rate  from  consumption 
of  all,  about  two  per  thousand,  and  Paris,  where  no  consumption 
hospitals  had  been  established,  still  had  its  four  deaths  per 
thousand  from  the  disease.  The  reduction  in  London  undoubt- 
edly had  been  due  in  large  part  to  the  segregation  of  the  con- 
sumptive poor  in  hospitals.  Lawrence  F.  Flick. 

12 


III.— INSTITUTIONS  IN  THE  UNITED  STATES 
AND  CANADA 

Arranged  in  alphabetical  order  according  to  states,  and  within  each  state  ac- 
cording to  location,  except  that  where  state  sanatoriums  exist  they  are  placed  first. 


ARIZONA 


ARIZONA 
PHOENIX. 

PaIvM  Lodge;  (1902)  : 

For  persons  who  are  in  the  very  early  stages  and  are 

able  to  move  about. 
Capacity:  In  Palm  Lodge,  30;  in  the  colony,  25. 
Terms :   $25  to  $35  per  week ;  in  the  tent  colony,  $9. 
Resident  Physician  and  Superintendent:  Henry  M.  Stone, 

M.  D. 

Palm  Lodge  is  two  miles  out  of  Phoenix,  within  one  block  of 
the  trolley.  The  altitude  is  -about  1,150  feet.  There  is  a  main 
building  of  stuccoed  brick,  containing  fifteen  rooms,  and  eight 
two  and  four  room  cottages,  each  supplied  with  its  own  bath- 
room. 

A  tent  colony  is  now  being  constructed,  two  miles  distant 
from  Palm  Lodge,  which  will  also  be  under  Dr.  Stone's  manage- 
ment. There  will  be  accommodations  for  twenty-five  and  the 
rate  of  nine  dollars  per  week  will  include  medical  attendance. 
It  is  expected  that  this  colony  will  be  completed  by  December  i, 
1904. 

Applications  for  admission  to  either  of  these  places  should 
be  addressed  to  Dr.  Henry  H.  Stone. 

Mkrcy  Hospitai,  (1893)  : 

Not  exclusively   for  the  treatment  of  tuberculosis,  but 
cases  of  consumption  are  received  at  any  stage  of  the 
disease,  and  cared  for  in  separate  wards  and  rooms. 
There  is  accommodation  for  20  consumptives. 
Terms  :  $14  per  week;  there  is  no  provision  for  free  treat- 
ment, but  exceptions  are  occasionally  made  in  cases  of 
extreme  poverty. 
No  resident  physician,  but  there  are  about  forty  on  the 
visiting  and  consulting  staff. 
The  hospital  is  in  charge  of  the  Sisters   of  Mercy  and  is 
supported  by  fees  from  patients.     It  is  housed  in  a  large  brick 
building,  surrounded  by  attractive  grounds,  five  blocks  out  of 
the  city  proper. 

Application  for  admission  should  be  made  to  the  Sister  Su- 
perior. 

15 


ARIZONA 


TUCSON. 

St.  Mary's  HospiTaIv   (Tuberculosis  annex  opened  in  De- 
cember, 1900)  : 
All  stages  of  pulmonary  tuberculosis  are  admitted,  and 
are  cared  for  in  a  separate  building,  called  St.  Mary's 
Sanatorium, 
Capacity:   30. 
Terms:   $15  per  week;  arrangements  are  made  to  receive 

free  of  charge  a  few  patients  unable  to  pay  anything. 
There  is  no  resident  physician. 

The  location  is  two  miles  from  the  city,  at  an  altitude  of  2,400 
feet.  The  tuberculosis  sanatorium  is  a  brick  building  built 
around  an  open  court,  with  a  porch  on  both  sides.  There  are 
no  wards.  Each  patient's  room  is  17  by  14  feet,  and  has  two 
windows  and  a  double  door.  The  institution  is  under  the 
charge  of  a  Roman  Catholic  sisterhood,  the  Sisters  of  St. 
Joseph. 

Application  should  be  made  to  the  Sister  Superior. 


16 


CALIFORNIA 


CAUFORNIA. 

State;  Sanatorium  : 

The  establishment  of  a  state  sanatorium  is  being  pressed 
by  the  State  Medical  Society,  through  its  Tuberculosis  Com- 
mittee.    (See  page  233.) 

ALTADENA. 

Espi^ranza,  a  sanatorium  for  bronchial  and  pulmonary  af- 
fections, conducted  by  the  Altadena  Health  Resort 
Company   (February,  1903)  : 
All   stages   of   consumption   are   received. 
Capacity :    50. 
Terms  :    $25  per  week. 
Resident  Physician :   F.  C.  Melton,  M.  D. 

The  Altadena  Health  Resort  Company  has  established  this 
sanatorium  on  a  tract  of  160  acres,  half  a  mile  east  of  Altadena, 
which  may  be  reached  from  Pasadena  by  electric  car  in  twenty 
miinutes.  On  the  north  the  place  is  protected  by  a  semi- 
circle of  mountains,  while  it  is  open  to  the  south  and  west,  com- 
manding a  wide  view  of  the  San  Gabriel  Valley.  The  altitude 
is  1,800  feet.  A  central  building  contains  offices,  dining-room 
and  parlors.  Most  of  the  patients  live  in  tent  cottages.  The 
lighting  is  by  electricity  and  all  the  buildings  are  connected  by 
telephone. 

Application  should  be  made  to  Dr.  F.  C.  Melton. 


17 


CAUI^ORNIA 


INDIO. 

Health  Camp  (January,  1903)  : 

Primarily  for  consumptives,  but  exceptions  are  sometimes 

made  in  favor  of  applicants  who  need  an  out-door  life 

for  other  reasons. 
Capacity:  practically  unlimited,  as  there  are   125   acres 

available  for  the  extension  of  the  tent  colony. 
Terms :  no  one  is  excluded  on  account  of  either  poverty 

or  wealth ;  those  able  to  pay  something  are  charged  $1 

per  week  or  more  for  the  use  of  a  furnished  tent  and 

$3  for  board. 
There  is  no  resident  physician. 

This  novel  adventure  is  supported  by  Mr.  N.  O.  Nelson,  a 
Saint  Louis  manufacturer,  who  bought  for  the  purpose  200 
acres  just  at  the  entrance  of  the  Great  Desert.  Indio  is  on  the 
Southern  Pacific  Railway,  half-way  between  Los  Angeles  and 
Yuma.  The  land  is  20  feet  below  sea  level,  in  the  Coachella 
Valley,  protected  from  wind  and  fog  on  both  sides  by  moun- 
tains. The  average  rain  fall  for  the  year  does  not  exceed  one 
inch,  and  all  winter  days  are  comfortably  warm.  The  ranch  is 
being  irrigated  and  beautified  and  buildings  are  being  erected 
for  the  use  of  the  colonists.  Their  individual  homes  are  floored 
tents  of  various  sizes.  Seventy-five  acres  are  now  under  culti- 
vation, and  it  is  hoped  that  the  produce  will  supply  the  camp. 
The  work  on  the  place  is  done  chiefly  by  the  able-bodied  colonists. 
Hospitality  is  extended  to  whole  families,  not  merely  to  the 
invalid  member,  and  provision  is  made  for  a  permanent  home 
for  convalescents. 

Application  should  be  made  to  N.  O.  Nelson,  either  at  Indio 
or  at  Leclaire,  Illinois. 


18 


CALIFORNIA 


LOS  ANGELES. 

Thu  Barlow  Sanatorium,  Incorporated  (September, 
1903)  : 

For  consumptives  who  have  been  residents  of  Los  An- 
geles County  for  at  least  one  year  and  who  are  without 
the  means  to  go  elsewhere ;  persons  in  all  stages  of  the 
disease  have  been  admitted,  but  it  is  desired  to  receive 
in  the  future  none  who  are  bed-ridden. 

Capacity:   15. 

Terms :  $5  or  $7  per  week  for  those  who  are  able  to  pay ; 
others  are  cared  for  free  of  charge. 

There  is  no  resident  physician,  but  the  three  visiting  phy- 
sicians are  within  easy  reach. 

The  plant  at  present  consists  of  25  acres  of  rolling  land,  on 
the  Chavez  Ravine  Road,  adjoining  the  large  city  park  and  sur- 
rounded by  it  on  three  sides,  an  administration  building  with 
detached  kitchen  and  laundry,  a  one-and-a-half-story  dormitory 
for  patients,  and  one  tent  cottage.  It  is  located  within  the  city 
limits,  but  away  from  car  lines  and  buildings.  The  altitude  is 
about  400  feet.  Voluntary  contributions  are  practically  the  only 
source  of  support.  Thus  far  no  debt  has  been  incurred  and  an 
endowment  fund  of  $6,000  has  been  secured.  The  average  cost 
per  week  per  patient  during  the  first  year  was  $12.35.  Seventy- 
five  applications  were  received  and  thirty-four  patients  cared  for 
during  the  year.  These  patients  came  originally  from  eleven 
states  of  the  union  and  eight  European  countries. 

Application  should  be  made  to  Dr.  W.  Jarvis  Barlow,  328 
330  Wilcox  Building,  Los  Angeles. 


19 


H 


CALIFORNIA 


MENTONE. 

The  Mentone  Sanatorium  (1903)  : 

Exclusively  for  early  cases  of  consumption. 

Capacity :   50. 

Terms:  $12.50  per  week  and  upward  for  board;   $10  per 

week  for  medical  treatment. 
Resident  Physician  :    Fred  J-  Koepke,  AI.  D. 
Visiting  Physicians :   Hoell  Tyler,  M.  D. ;  C.  A.  Sanborn, 

M.  D.,  and  S.  Y.  Wynne,  M.  D. ;   all  of  Redlands. 

Mentone  is  one  mile  from  Redlands,  in  a  valley  protected  on 
three  sides  by  mountains,  while  to  the  west  stretch  miles  of 
orange  and  lemon  groves.  The  altitude  is  1,700  feet.  This 
sanatorium  is,  strictly  speaking,  a  hotel  where  well-to-do  patients 
can  have  sanatorium  treatment  and  where  their  relatives  and 
friends  are  also  received.  Tents  are  provided  on  the  grounds 
for  patients  who  prefer  to  sleep  out  of  doors. 

Applications  should  be  addressed  to  A.  R.  Schultz,  Manager. 


21 


The  Pottenger  Sanatorium. 


Distant  View  of  the  Pottenger  Sanatorium. 


CMvlFORNIA 


MONROVIA. 

The  Pottknger  Sanatorium  for  Diseases  of  the  Lungs 
AND  Throat  (December,  1903)  : 

For  the  treatment  of  cases  of  pulmonary  and  laryngeal 
tuberculosis  which  offer  a  fair  chance  of  permanent  and 
material  improvement ;  no  patients  are  received  in 
whom  the  disease  is  so  far  advanced  that  their  condi- 
tion will  discourage  those  who  are  in  the  early  stages. 

Capacity :  26 ;  by  January,  1905,  there  will  be  room  for  40. 

Terms  :  a  few  at  $25  per  week,  the  rest  $30  and  up. 

Resident  Physician  :    F.  M.  Pottenger,  M.  D. 

This  sanatorium  is  sixteen  miles  east  of  Los  Angeles,  in 
the  foot  hills  of  the  Sierra  Madre  Mountains,  at  an  elevation 
'of  1,000  feet  above  the  sea.  Monrovia  is  on  the  main  line 
of  the  Monrovia  and  Duarte  branch  of  the  Southern  Pacific 
Railway,  and  the  Monrovia  branch  of  the  Pacific  Electric 
Railway.  The  site  is  a  natural  park  of  over  eight  acres,  occupy- 
ing an  eminence  400  feet  above  the  town,  above  the  fogs  and 
protected  from  storms.  From  its  commanding  location  there  is 
an  uninterrupted  view  of  the  San  Gabriel  valley,  with  its  world- 
famed  orange  groves,  and  the  Sierra  Madre  Mountains.  There 
are  at  present  a  central  administration  building,  one  cottage,  a 
sun  parlor  and  open-air  pavilion,  and  a  number  of  tent  houses. 
The  plans  for  further  buildings  contemplate  three  pavilions,  con- 
nected by  corridors  and  balconies,  and  containing  sixty  rooms 
facing  south.  One  of  these  pavilions  will  be  ready  for  occu- 
pancy in  January,  1905.  All  the  buildings  and  furnishings  are 
in  accordance  with  the  latest  dictates  of  sanitary  science.  There- 
is  a  well-equipped  clinical  laboratory,  and  a  laboratory  for  ex- 
perimental and  research  work  will  soon  be  constructed. 

Application  should  be  made  to  Dr.  F.  JNL  Pottenger. 


23 


CALIFORNIA 


REDLANDS. 

The  Settlement  (1901)  : 

For  needy  consumptives  already  in  Redlands,  in  any  stage 
of  the  disease ;  no  one  from  outside  can  be  received. 

Capacity :  17, 

Terms :  those  v^ho  are  able  to  pay  something  are  ex- 
pected to  do  so,  up  to  a  maximum  of  five  dollars  per 
week;    for  the  destitute  care  is  entirely  free. 

Medical  Directors  :   Drs.  ]\Ioseley  and  Ide. 

The  Settlement  is  located  on  forty  acres  of  rolling  land,  not 
under  irrigation,  six  miles  from  the  city,  at  an  elevation  of  1,500 
feet.  All  patients  live  in  tents,  which  are  supplied  with  the  ordi- 
nary necessities,  but  of  a  verv  primitive  kind.  A  wooden  build- 
ing contains  the  dining  room,  kitchen,  store  room,  and  bath. 

This  sanatorium  camp  was  established,  and  is  maintained, 
exclusively  for  consumptives  who  find  themselves  stranded  in 
Redlands  without  funds,  or  with  insuinficient  money  to  provide 
themselves  with  proper  care.  It  is  supported  chiefly  by  contri- 
butions ;  there  are  countv  and  city  appropriations  aggregating 
$75  per  month ;  and  a  small,  irregular  amount  is  derived  from 
patients'  fees. 

The  demands  of  the  locality  absolutely  prohibit  the  reception 
of  patients  from  any  other  place.  Residents  of  the  town  who 
desire  to  be  admitted  should  apply  to  the  ]\Iatron  or  to  one  of 
the  INIedical  Directors. 


24 


COLORADO 


COLORADO 

AMITY  (Prowers  County). 

Emma  Booth  Tucki^r  Mijmorial  Sanitarium   for  Con- 
sumptives (November,  1904)  : 
Exclusively  for  early  cases  of  pulmonary  tuberculosis. 
Capacity:  100,  but  this  can  be  increased  almost  indefinite- 
ly by  the  addition  of  tents. 
Terms  :$25  per  month,  including  all  expenses  except  laun- 
dry ;    there  will  probably  be  arrangements  for  admit- 
ting needy  patients  free  of  charge. 
Resident  Physician :    Dr.  Greenard. 

This  sanatorium  has  been  established  by  the  Salvation  Army 
in  memory  of  Mrs.  Booth  Tucker.  It  is  located  on  an  isolated 
part  of  the  Salvation  Army  Farm  Colony  in  southeastern  Colo- 
rado. It  is  in  the  midst  of  the  great  plains  and  has  an  altitude 
of  3,500  feet.  The  Administration  Building  is  a  large  three- 
story  structure  of  rock.  It  will  contain,  in  addition  to  the  din- 
ing room,  library,  and  other  public  rooms,  some  sleeping  accom- 
modations. Most  of  the  patients,  however,  will  be  housed  in 
substantially  built  tent  cottages. 

Application  for  admission  should  be  made  to  the  Secretary. 


25 


COLORADO 


COLORADO  SPRINGS. 

NoRDRACH  Ranch  (November,  1901")  : 

For  early  cases  of  consumption  excliisivel}^ 

Capacity:  35  at  present,  with  plans  to  enlarge  soon  to 

accommodate  50. 
Terms :  $60  per  month,  which  includes  everything  except 

a  special  nurse  in  case  one  is  needed. 
Resident  Physician :  John  E.  White,  M.  D. 
Nordrach  Ranch  is  fortunate  in  its  location.  At  an  altitude 
of  6,000  feet,  quite  removed  from  the  dust  and  smoke  of  the 
city,  it  is  protected  on  the  north  by  Austin  Bluffs,  and  lias 
in  front  an  uninterrupted  view  of  Colorado-  Springs,  three  miles 
distant,  and  the  range  of  mountains. 

The  central  building  is  of  red  stone  and  contains  twenty-four 
rooms,  six  of  which  are  reserved  for  patients  who  may  tem- 
porarily need  hospital  care.  The  ordinary  sleeping  apartments 
for  the  patients  are  octagonal  tents,  communicating  directly  with 
the  nurses'  tent  by  electric  bells.  Practically  all  the  time  is  spent 
in  the  open  air.  The  resident  physician  sees  each  guest  at  least 
twice  a  day  and  the  physicians  in  Colorado  Springs  are  always 
available  for  consultation. 

The  only  source  of  income  so-  far  has  been  the  fees  from 
patients.  An  endowment  is  much  desired,  in  order  that  some 
charitable  work  may  be  done. 

Applications  should  be  addressed  to  M.  E.  Harper,  Business 
Manager. 

Glockniir  Sanitarium  (1888)  : 

Not  especially  for  tuberculosis,  but  consumptives  in  any 

stage  are  received. 
Capacity :  50. 
Terms  :  $8  to  $40  per  week. 

There  is  no  resident  physician;  the  management  is  in  the 
hands  of  a  Roman  Catholic  Sisterhood. 

Applications  should  be  addressed  to  Sister  Rose  Alexius. 


27 


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COI^ORADO 

DENVER. 

The  Agnes  Memorial  Sanatorium  (September,  1904)  : 

Exclusively  for  early  cases  of  pulmonary  tuberculosis ; 
when  accommodations  are  limited,  preference  will  be 
given  to  candidates  from  western  Pennsylvania. 

Capacity:  100;  this  number  is  to  be  increased  by  the  use 
of  house  tents. 

Terms:  $7  to  $10  per  week,  which  includes  medical 
attendance  and  ordinary  nursing. 

Superintendent  and  Medical  Director :  G.  Walter  Hold- 
en,  M.  D. 

This  Sanatorium  has  been  erected  by  Mr,  Lawrence  C. 
Phipps,  of  Pittsburg,  as  a  memorial  to  his  mother.  There  are 
five  buildings — a  three-story  administration  building,  an  infirm- 
ary, two  pavilions  and  a  power  house — all  in  the  old  Spanish 
Mission  style  of  architecture. 

In  the  administration  building  are  the  reception  room,  board 
room,  offices,  dining  rooms  and  kitchen,  besides  a  library  of 
1,500  bound  volumes  for  the  use  of  the  patients.  In  this  build- 
ing also  are  the  quarters  of  the  administrative  staff  and  at- 
tendants. 

The  medical  building  contains  on  the  first  floor,  besides  a 
very  complete  laboratory  and  treatment  rooms,  reception  and 
consultation  rooms.  The  second  floor  is  devoted  entirely  to  an 
infirmary,  which  is  provided  with  a  well-equipped  operating 
room.  There  are  two  pavilions,  one  for  men  and  the  other  for 
women,  opening  upon  wide  porches,  divided  by  canvas  partitions 
for  sleeping  purposes. 

The  power  house  furnishes  electricity,  ice  and  refrigeration, 
together  with  power  for  an  electric  laundry.  This  laundry  is 
equipped  with  the  most  modern  appliances,  including  a  complete 
sterilizer.  Sputum,  garbage  and  sweepings  are  disposed  of  in  a 
special  device  for  cremation. 

The  grounds  include  160  acres  of  dry,  sandy  soil  on  the 
plains  east  of  Denver,  at  the  highest  elevation  near  the  city,  about 
5,400  feet.  The  distance  from  the  heart  of  the  city — over  seven 
miles — and  the  extent  of  the  estate,  ensure  against  smoke  and 
dust.  The  Sanatorium  is  at  Sixth  and  Hyde  Park  Avenues, 
reached  from  Denver  in  thirty  minutes  by  electric  cars. 

Application  should  be  made  to  Dr.  G.  Walter  Holden,  Mont- 
clair  Station,  Denver. 

29 


COIvORADO 


The  Association  Health  Farm  (May,  1903)  : 

Especially  for  early  cases  of  pulmonary  tuberculosis,  but 
occasionally  others  in  need  of  out-door  life  are  received. 
For  young  men  of  limited  means  who  have  a  good 
prospect  of  recovery ;  preference  is  given  to  members 
of  the  Young  Men's  Christian  Association. 

Capacity :  45,  one  man  in  each  tent. 

Terms  :  $25  per  month ;  light  work  in  partial  payment  of 
this  charge  is  provided  for  many,  but  cannot  be  guar- 
anteed until  the  physical  condition  of  the  applicant  is 
fully  understood;  the  patient's  knowledge  of  farm 
work  is  also  taken  into  account. 

Resident  Physician :   John  Wethered,  M.  D. 

This  Kealth  Farm  originated  in  the  experience  of  the  Colora- 
do Young  Men's  Christian  Association  in  dealing  with  the  prob- 
lem of  finding  suitable  places  for  the  young  men  who  go  to 
Colorado  from  all  parts  of  the  country  in  search  of  health. 
Funds  for  the  execution  of  the  plan  to  its  present  stage  have 
been  provided  by  friends  in  various  parts  of  the  country, 
the  principal  gifts  having  been  made  by  Mr.  and  Mrs.  David 
Brothers  and  Dr.  E.  P.  George.  Many  of  the  Young  Men's 
Christian  Associations  throughout  the  country  have  given  tents 
completely  furnished  and  others  are  planning  to  do  the  same. 
The  value  of  the  present  equipment  is  $45,000. 

The  Farm  consists  of  two  tracts  of  land.  The  tract  which 
is  now  being  improved  contains  thirty-four  acres  of  fruit  land 
five  and  one-half  miles  northwest  of  the  city,  on  the  Denver, 
Lakewood  and  Golden  Railroad.  There  is  a  station  at  the 
corner  of  the  farm.  The  sixty  acres  of  unimproved  land  will  be 
developed  whenever  the  funds  allow.  The  site  of  the  present 
farm  is  5,400  feet  above  sea  level  and  has  a  diversity  of  natural 
features.  The  improvements  include  an  administration  build- 
ing, stables,  forty-five  cottage  tents,  a  water-tower  observatory, 
and  a  tent  hospital.  From  the  first  the  number  of  applicants  has 
far  outnumbered  the  places  for  them. 

Inquiries  should  be  addressed  to  W.  M.  Danner,  Secretary, 
1 73 1  Arapahoe  Street,  Denver. 


30 


The  San  Francisco  Tent,  Association 
Health  Farm. 


The  Saint  Louis  Tent,  Association 
Health  Farm. 


COI^ORADO 

FoxHALiv,  133  West  Colfax  Avenue  (1901)  : 

For  a  few  selected  patients  who  offer  reasonable  pros- 
pects of  ultimate  recovery. 
Capacity:   10-15. 
Terms  :  $25  per  week. 
Resident  Physician  :    Wm.  N.  Beggs,  A.  B.,  M.  D. 

Foxhall  is  located  opposite  the  public  library,  three  blocks 
from  the  Capitol.  It  is  a  single  large  house,  the  home  of  Dr. 
Beggs,  who  is  one  of  the  physicians  to  the  National  Jewish  Hos- 
pital for  Consumptives  and  editor  of  the  Colorado  Medical  Jour- 
nal. No  patient  is  allowed  to  remain  who  refuses  absolute  obe- 
dience to  directions. 

Application  should  be  made  to  Dr.  Wm.  N.  Beggs. 


The:  Home: 

"The  only  rec[uirements  for  admission  are  that  a  person 
is  worthy  of  a  Christian  home  and  presents  a  good 
chance  of  being  benefited  by  the  climate,  and  presents  a 
letter  from  some  clergyman  or  from  some  one  the 
superintendent  knows." 

Capacity:  150. 

Terms :  $25  per  week  for  those  who  require  a  nurse ; 
there  is  one  building,  accommodating  40  persons,  in 
which  the  charges  are  $25  per  month. 

There  is  no  resident  physician. 

The  Home  comprises  four  buildings :  St.  Andrew's  House 
for  men,  Grace  House  for  mother  and  son  or  husband  and  wife. 
Emily  House  for  women,  and  Heartsease  for  the  very  sick. 
These  cover  an  entire  block  of  land,  and  are  connected  by  glass 
covered  porches.  The  Home  is  ten  minutes'  ride  by  three  car 
lines  to  the  Denver  post  office,  and  is  so  situated  that  it  com- 
mands a  view  of  the  entire  city,  the  plains  for  hundreds  of 
miles,  and  the  Rockies  for  one  hundred  and  fifty  miles.  It  is 
under  the  direct  ownership  and  management  of  the  Episcopal 
Church  of  the  Diocese  of  Colorado. 

Application  should  be  made  to  Rev.  Frederick  W.  Oakes, 
Superintendent. 

33 


COIvORADO 


The    NationaIv    Je;wish     Hospitai,     for     Consumptive;s 
(1899): 
For  "indigent  consumptives  of  whom  the  examining  phy- 
sicians give  a  fair  or  good  prognosis." 
Capacity :  88. 

There  is  no  charge  of  any  kind. 
Superintendent:  Moses  ColHns,  M.  D. 

While  this  institution  is  within  the  Hmits  of  Denver,  it  is 
nevertheless  sufficiently  removed  from  the  congested  part  of  the 
city  to  have  an  abundance  of  the  sunshine  and  the  pure,  invigor- 
ating air  for  which  Colorado  is  noted.  The  altitude  is  about 
5,200  feet.  The  buildings  are  on  the  pavilion  plan,  containing 
rooms  of  from  one  to  four  beds  and  twelve-bed  wards. 

Application  for  admission  must  be  made  from  the  city  where 
the  applicant  resides,  on  prescribed  forms.  The  applicant  must 
be  examined  by  the  physician  appointed  by  the  hospital  authori- 
ties at  the  place  where  he  resides,  and  the  application  must  be 
sent  on  blanks  provided  for  that  purpose.  No  other  form  of 
medical  examination  will  be  accepted,  nor  any  made  by  other 
than  the  regularly  appointed  physician.  The  patient's  charac- 
ter must  be  investigated  and  endorsed  by  the  local  trustee. 
Each  application  must  be  accompanied  by  a  guaranty,  approved 
also  by  the  local  trustee  or  director,  that  the  patient  shall  not 
become  a  charge  upon  the  community  after  he  leaves  the  hospi- 
tal, and  that  in  case  his  return  may  be  advisable  at  any  time 
his  transportation  will  be  furnished.  No  applicant  should  be 
sent  to  Denver,  or  allowed  to  go,  until  he  has  received  official 
notice  of  his  admission. 

For  the  name  and  address  of  the  examining  physician  in  any 
city,  inquiry  should  be  sent  to  Alfred  Muller,  Secretary,  Ernest 
and  Cranmer  Building,  Denver. 


34 


COLORADO 


EDGEWATER. 

Sanitarium  of  The  Jewish  Consumptives'  ReeiEE  Socie- 
ty (September,  1904)  : 
For  destitute  Jewish  consumptives. 
Capacity:   12. 
There  is  no  resident  physician  at  present. 

This  society  was  formed  a  few  months  ago  by  Jewish  resi- 
dents of  Denver,  most  of  whom  were  cured  consumptives,  with 
the  object  of  helping-  their  co-reHgionists  who  have  gone  to 
Colorado  in  the  hope  of  regaining  their  health,  but  have  come  to 
want  before  they  have  recovered.  A  tract  of  twenty  acres  of 
land  has  been  purchased  in  the  suburbs  of  Denver,  three-quar- 
ters of  a  mile  out  of  the  city,  a  dining-room  and  a  kitchen  have 
been  erected,  and  twelve  tents  have  been  installed  and  furnished. 
It  is  hoped  to  increase  the  capacity  to  one  hundred  by  the  end  of 
the  first  year.  It  is  planned  to  establish  a  dairy,  a  poultry  yard, 
and  vegetable,  fruit  and  flower  gardens,  the  produce  from  which 
will,  it  is  expected,  supply  the  camp.  Patients  who  are  able  will 
do  light  work  connected  with  these  enterprises,  but  under  the 
direct  supervision  of  a  physician. 

Applications  should  be  addressed  to  Dr.  C.  D.  Spivak,  Sec- 
retary, 142 1  Court  Place,  Denver. 


35 


Resthaven  in  the  Pines. 


DiNiNG-RooM,  Resthaven. 


COLORADO 


MORRISON. 

ResthavjJn,  Sunrise  Mountain  Park  (June,  1901)  : 

For  young  men  and  women  of  limited  means,  in  the  in- 
cipient stage  of  tuberculosis. 

Capacity :  50. 

Terms :  $25  per  month. 

There  is  a  permanent  resident  physician ;  Dr.  I.  Single- 
ton Garthwaite,  of  Denver,  visits  frequently,  and  to 
him  all  applicants  must  present  themselves  before  ad- 
mission will  be  granted. 

Sunrise  Mountain  Park,  the  site  of  Resthaven,  has  an  alti- 
tude of  5,800  feet,  and  all  the  advantages  in  the  way  of  scenery 
that  the  Rockies  and  the  great  plains  can  provide.  Morrison, 
the  nearest  station,  on  the  Colorado  and  Southern  Railroad,  is 
five  miles  distant.  The  buildings  are  one-room  cottages  and 
tents  scattered  among  the  pines  and  bearing-  the  names  of  the 
states  which  have  donated  them.  An  endowment  from  Lillian 
Garthwaite-^^■ylie  and  various  other  gifts  supplement  the  fees 
received  from  patients. 

Heretofore  Resthaven  has  been  open  only  from  June  i  to 
October  i ,  but  a  building-  is  now  being  erected  which  will  permit 
an  all-year  season. 

Applications  should  be  made  to  Dr.  I.  Singleton  Garthwaite, 
322  Temple  Court  Building,  Denver. 


37 


Dr.  Brooks's  Sanatorium. 


The  Veranda,  Dr.  Brooks's  Sanatorium. 


CONNECTICUT 


COXXECTICUT 

State  vSaxatorium  : 

Agitation  for  a  state  sanatorium  was  begun  by  the  state 
Board  of  Health  and  others  three  years  ago.  Twenty-five  thou- 
sand doUars  was  granted  by  the  legislature  to  a  private  institu- 
tion, the  Gaylord  Farm  Sanatorium  (See  page  41  j,  but  no  state 
institution  has  yet  been  established. 

NEW  CANAAN. 

Dr.  Brooks'  Sanatorium  (1897")  : 

For  consumptives  whose  condition  does  not  preclude  the 
possibility  of  at  least  an  arrest  of  the  disease. 

Capacity :  24. 

Terms :  $25  to  v$35  per  week,  including  everything,  ac- 
cording to  the  room  chosen ;  no  free  beds. 

Resident  Physician  :    ~Sl.  ].  Brooks,  ^M.  D. 

This  institution  is  situated  one  mile  from  the  village,  on  a 
ridge  of  the  Berkshire  foothills,  at  an  altitude  of  about  800  feet. 
The  grounds  cover  about  eighteen  acres,  part  of  which  is  wood- 
land. The  individual  sleeping  apartments  are  10  by  16  feet  and 
10  feet  high.  There  are  no  wards.  Patients  are  under  the 
strictest  hygienic  routine,  constant  medical  supervision  and  con- 
stant efficient  nursing.  The  average  course  of  treatment  covers 
twelve  weeks ;  no  patients  are  retained  longer,  and  a  total  arrest 
of  the  disease  is  expected  within  this  period. 

Application  for  admission  should  be  made  to  either  of  the 
following:  Dr.  ^I.  J.  Brooks,  New  Canaan,  Conn.;  Dr.  Hubert 
Arrowsmith,  170  Clinton  Street,  Brooklyn,  X.  Y. 


39 


COXXECTICUT 


WALLINGFORD. 

Gaylord  Farm  Sanatorium  (September,  1904)  : 

Exclusively  for  persons  in  the  early  stages  of  pulmonary 
tuberculosis  who  are  of  very  moderate  means  and  resi- 
dents of  the  state. 

Capacity :  30. 

Terms  :  $7  per  week. 

^Medical  Superintendent :    David  R.  Lyman,  M.  D. 

This  sanatorium  is  due  to  the  efforts  of  the  Xew  Haven 
County  Anti-Tuberculosis  League,  and  is  under  its  management. 
Situated  on  a  plateau  two  miles  from  the  town  and  above  it,  and 
fourteen  miles  inland  from  New  Haven,  the  Sanatorium  over- 
looks the  towns  of  Wallingford  and  Meriden  and  the  valley  in 
which  they  lie.  The  altitude  is  390  feet.  There  is  an  adminis- 
tration building,  containing  offices,  rooms  for  the  doctor  and 
matron,  recreation  hall  and  accommodations  for  fourteen  pa- 
tients. Four  cottages  provide  for  four  patients  each,  in  rooms 
opening  on  porches.  The  kitchen,  dining  room,  and  laundry 
are  in  separate  buildings.  There  is  electric  lighting  and  steam 
heat  throughout  and  the  water  supply  is  from  artesian  wells.  In 
connection  with  the  Sanatorium  is  a  farm  of  250  acres. 

The  charge  to  patients  does  not  cover  the  cost  of  mainten- 
ance.    A'oluntary  contributions  are  the  chief  source  of  income. 

Applications  should  be  addressed  either  to  Dr.  David  R.  Ly- 
man, Wallingford,  or  to  one  of  the  consulting  physicians,  as  fol- 
lows :  Dr.  C.  \\'.  Gaylord,  Branford ;  Dr.  S.  D.  Otis,  ]\Ieriden  ; 
Dr.  J.  P.  C.  Foster,  Xew  Haven ;  Dr.  O.  T.  Ostborne,  Xew 
Haven  :  Dr.  Henry  L.  Swain,  X^ew  Haven  ;  Dr.  F.  \\'.  AA'right,. 
X^ew  Haven  ;    Dr.  Carl  E.  ]\Iuno-er.  AVaterburv. 


41 


DISTRICT  OF  COLUMBIA,  FLORIDA 

DISTRICT  OF  COLUMBIA 
WASHINGTON. 

Washington  Asylum  Hospital: 

A  general  hospital  for  the  poor  of  the  District ;  consump- 
tives are  treated  in  tent  wards. 

Capacity  of  tents  :  34. 

There  is  no  provision  for  pay  patients. 

Visiting  Physician :    D.  Percy  Hickling,  M.  D. 

Consulting  Board :  Drs.  G.  Lloyd  Magruder,  W.  P.  Carr, 
W.  S.  Bowen,  J.  Tabor  Johnson,  H.  L.  E.  Johnson,  H. 
S.  Dye,  Swan  M.  Burnett,  F.  T.  Chamberlain,  George 
M.  Kober. 

There  are  three  resident  physicians. 

The  first  ten  was  erected  in  April,  1904.  Three  others  have 
been  added  since,  until  there  is  provision  for  both  white  and 
colored  men  and  women.  Three  of  the  tents  are  entirely  of 
wood,  open  on  the  south  side,  and  with  an  elevated  roof  for 
A'entilation. 

The  tents  have  been  erected  on  the  hospital  grounds  in  the 
eastern  part  of  the  city,  near  the  Anacostia  River. 

Application  for  admission  should  be  niade  to  the  Board  of 
Charities  of  the  District  of  Columbia. 


FLORIDA 
PENSACOLA. 

Naval  Hospital  : 

A  tuberculosis  camp,  consisting  of  tents  accommodating  fifty 
patients,  has  been  established  in  the  grounds  of  this  hospital,  as 
a  temporary  device  for  meeting  the  exigent  needs  of  the  Depart- 
ment of  the  Navy.  The  Bureau  of  Medicine  and  Surgery  of 
the  Department  is  making  a  study  of  the  various  abandoned 
army  posts  which  have  favorable  locations,  with  a  view  to  the 
establishment  of  a  sanatorium  for  the  treatment  of  cases  of 
tuberculosis  arising  in  the  United  States  Navy  and  United 
States  Marine  Corps.  The  authority  of  Congress  will  be  neces- 
sary before  title  to  any  selected  post  can  be  acquired  by  the 
Department  and  work  begun. 


42 


HAWAII,  Illinois 


HAWAII 
HONOLULU. 

Honolulu  Home;  for  Incurables  (1902)  : 

Patients  are  received  in  any  stage  of  the  disease  and  are 

cared  for  in  a  separate  building. 
Capacity :    24. 
Terms :  there  are  8  free  beds ;  for  others  the  charge  is 

$1.50  per  day. 
Medical  Superintendent:   A.  H.  Sinclair,  M.  D. 

The  situation  is  two  miles  from  the  sea,  at  an  elevation  of 
300  feet.  The  building  for  consumptives  contains  a  free  ward 
and  separate  rooms  for  pay  patients.  Support  is  derived  partly 
from  endowments  and  partly  from  a  territorial  appropriation. 

Application  should  be  made  to  Dr.  A.  H.  Sinclair. 


ILLINOIS 
Statl  Sanatorium  : 

A  committee  of  the  State  Medical  Society  has  been  ap- 
pointed with  the  express  object  of  securing  the  establishment 
of  a  state  sanatorium.     (See  pages  45,  236.) 

CHICAGO. 

St.  Ann's  Sanitarium,  49th  and  Thomas  Streets  (1903)  : 
For  early  cases  of  consumption. 

Capacity:    128  at  present;  accommodation  for  350  pro- 
posed. 
Terms:    $8  to  $20  per  week,  with  the  exception  of  15 

free  beds. 
Medical  Director:  A.  F.  Kramps,  M.  D. 

This,  the  first  institution  in  Chicago  devoted  exclusively  to 
the  treatment  of  pulmonary  tuberculosis,  is  located  northeast 
of  the  suburb  of  Austin.  Funds  for  the  building  were  supplied 
by  gifts  secured  mainly  through  the  efforts  of  the  Roman 
Catholic  sisterhood  in  charge  of  the  sanatorium.  Current  ex- 
penses are  met  by  fees  from  patients  and  contributions. 

Application  should  be  made  to  the  Sister  Superior. 


43 


ILLINOIS 
DUNNING. 

Cook  County  Hospital  for  Consumptives  (1899)  : 

For  poor  consumptives  of  Cook  County;  patients  ad- 
mitted are  presumably  dependent,  but  in  consideration 
of  the  slight  provision  for  this  disease  in  Chicago  no- 
close  inquiry  is  made  on  this  point;  all  stages  are 
treated. 

Capacity :  in  old  building,  400 ;  in  new  modern  hospital^ 
opened  in  April,  1904,  160. 

All  beds  are  free. 

Resident  Physician  :  ^I.  G.  McHugh,  M.  D. 

This  hospital  is  seven  miles  west  of  Lake  [Michigan,  on  the 
highest  point  in  the  county,  800  feet  above  sea  level.  Other 
natural  features  are  the  same  as  are  found  in  Chicago.  The 
original  building  is  of  brick,  three  stories  high ;  the  new  hospital 
consists  of  four  frame  one-story  wards,  connected  by  a  large 
solarium-hall,  and  a  two-story  administration  building. 

Application  for  admission  should  be  made  to  the  County 
Agent,  185  South  Clinton  Street,  Chicago. 


OTTAWA. 

Text  Colony  (July,  1904)  : 

For  early  cases  of  pulmonary  tuberculosis. 

Capacity :    40. 

Terms:    for  those  who  can  afford  to  pay  $10  per  week 

is  charged,  which  about  covers  cost  of  maintenance. 
Aledical  Director:  J.  \V.  Pettit,  ^[.  D. 

This  little  experimental  colony,  under  the  auspices  of  the 
Illinois  State  ^Medical  Society,  is  located  on  a  bluff,  120  feet 
above  the  Illinois  River.  The  tents  are  arranged  around  a 
quadrangle  in  the  center  of  the  ten-acre  tract  which  constitutes 
the  grounds.  The  kitchen,  dining-room,  and  parlor,  as  well  as 
the  sleeping  rooms,  are  separate  tents,  of  waterproof  cloth, 
with  wood  floors,  and  lighted  by  electricity.  Patients  are 
received  from  any  part  of  the  state. 

Applications  for  admission  should  be  addressed  to  Dr.  J.  W.. 
Pettit. 

45 


INDIANA,   IOWA 

INDIANA 


State  Sanatorium 


Efforts  to  secure  the  establishment  of  a  state  sanatorium 
have  been  made  by  the  State  Medical  Society  during  the  last 
four  years.  In  1903  a  resolution  appointing  a  commission  to 
investigate  the  subject  was  defeated  in  the  legislature.  A  state 
association  (see  page  237)  has  recently  been  formed  with  the 
primary  object  of  securing  a  state  institution. 

FORT  WAYNE. 

St.  Rochus  Hospital  is  a  small  building  where  ten  consump- 
tives can  be  cared  for  by  the  Sisters  of  "The  Poor  Hand  Maids 
of  Jesus  Christ."  It  is  hoped  by  the  Sisters  that  in  the  course  of 
lime  they  will  be  able  to  erect  a  hospital  worthy  of  the  name. 

INDIANAPOLIS. 

Flower  AIission  Pavilion  eor  Incurables,  City  Hospital 
(January,  1904)  : 
For   incurable    cases    of   consumption   who    are    recom- 
mended by  the  Flower  Mission  Society  and  approved 
by  the  Superintendent  of  the  Hospital. 
Capacity :    26. 
There  are  no  charges. 
Superintendent:  Paul  Frederic  Martin,  M.  D. 

The  new  pavilion  occupies  the  northern  part  of  the  City 
Hospital  grounds,  which  have  an  altitude  of  822  feet.  It  is 
a  one-story  brick  building,  surrounded  by  a  veranda,  containing 
two  wards  for  ten  beds  each  and  six  private  rooms. 

Applications  should  be  addressed  to  Mrs.  John  L.  Griffith, 
President  of  the  Flower  Mission  Society. 

IOWA 

State  Sanatorium  : 

At  the  last  session  of  the  legislature  the  Board  of  Control 
of  State  Institutions  was  requested  to  make  an  investigation  in 
regard  to  the  treatment  of  tuberculosis  in  sanatoriums,  as  a  pre- 
liminary step  to  considering  the  establishment  of  a  state  institu- 
tion. One  thousand  dollars  was  appropriated  for  the  expenses 
of  the  inquiry. 

46 


IOWA,  KANSAS,   KENTUCKY,  LOUISIANA 


FORT  DODGE. 

Boulde;r  Lodge:  Sanatorium   (July,  1901)  : 

Exclusively  for  the  treatment  of  early  cases  of  all  forms 

of  tuberculosis. 
Capacity:    15. 
Terms  :   $20  per  week. 
Medical  Director:  J.  W.  Kime,  M.  D. 

The  building  is  of  unshaped  field  boulders,  two  stories  high, 
in  a  wooded  tract  of  15  acres,  1,200  feet  above  sea  level.  The 
surrounding  country  is  wild  woodland,  sloping  down  to  the 
Des  Moines  River  on  the  west. 

Application  should  be  made  to  Dr.  J.  W.  Kime. 


KANSAS 
State  Sanatorium  : 

A  committee  of  the  State  Medical  Society  is  framing  a  bill 
to  present  to  the  legislature.  The  State  Board  of  Health  and 
others  interested  will  co-operate  in  supporting  the  measure. 


KENTUCKY 

State  Sanatorium  : 

For  the  past  four  years  the  establishment  of  a  state  sana- 
torium has  been  recommended  to  the  general  assembly,  but  no 
action  has  vet  been  taken. 


LOUISIANA 
State  Sanatorium  : 

Agitation  for  a  state  institution  has  been  begun  by  the  State 
Board  of  Health,  but  little  progress  has  yet  been  made. 


47 


Ground  Plan  of  the  Maine  Sanatorium. 


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TE/APOPfARr    HEADQUARTERS 
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The  Maine  SanatoriuiM. 


MAINE 


MAINE 
HEBRON. 

The;  Maine  Sanatorium,  Greenwood  Mountain   (Novem- 
ber I,  1904)  : 

Nearest  stations :  West  Minot,  on  Portland  and  Rumford 

Falls  Railroad ;    Paris,  on  Grand  Trunk. 
Exclusively  for  incipient  cases  of  pulmonary  tuberculosis. 
Capacity:  ultimately  100;  at  present  there  is  room  for  30. 
Terms  :  6  free  beds ;  $10  per  week  for  the  others. 
Medical  Director:  Estes  Nichols,  M.  D. 

The  State  Association  for  the  Treatment  of  Tuberculosis,  to 
v/hose  efforts  this  sanatorium  is  due,  has  secured  330  acres  on 
a  southern  slope  in  the  foothills  of  the  White  Mountains,  at  an 
altitude  of  1,200  feet,  near  the  Poland  Spring-  region.  A  public 
highway  runs  through  the  center  of  the  tract.  Over  a  third  of 
tlie  estate  is  fertile  arable  land,  which  will  make  it  possible  to 
produce  the  required  supplies  of  milk,  fruit  and  vegetables. 
One  hundred  and  thirty-five  acres  are  woodland.  The  build- 
ings are  on  the  cottage  system  with  individual  sleeping  rooms,, 
hog  camps,  open  on  one  side,  are  to  be  constructed  for  winter 
sitting-rooms.  The  sleeping  pavilions  have  across  the  entire 
front  double  glass  doors  which  are  closed  only  while  patients  are 
rising  and  retiring.  Patients  do  not,  however,  dress  in  these 
pavilions,  but  go  directly  from  them  into  heated  dressing-rooms. 
It  is  hoped  that  the  endowment  will  soon  allow  an  increase  in  the 
number  of  free  patients  who  can  be  received. 

Applications  should  be  sent  to  Dr.  Estes  Nichols. 


49 


MARYLAND 


MARYLAND 

State  Sanx\torium  : 

The  State  Tuberculosis  Commission  (see  page  237)  is  au- 
thorized to  consider  the  question  of  state  sanatoriums  and  report 
to  the  General  Assembly  in  January,  1906. 

BALTIMORE. 

City  Hospital  for  Consumptives,  in  connection  with  Bay 
View  Asylum  (to  be  opened  in  1905)  : 

For  the  phthisis  patients  in  the  City  Hospital. 
There  will  be  accommodation  for  100  of  the  poor  con- 
sumptives of  the  city. 
No  pay  patients  are  received. 

Chief  Resident  Physician :  William  H.  Smith,  M.  D. 
There  is  a  small  two-story  building  for  women  on  the 
grounds  of  the  City  Almshouse  and  Hospital.  The  new  build- 
ing for  men,  now  in  process  of  erection,  will  be  150  feet  long 
and  two  stories  high.  The  hospital  buildings  are  160  feet  above 
tide  water. 

Admission  is  through  the  Supervisors  of  City  Charities. 


50 


MARYLAND 

TOWSON. 

The  Hospital  for  Consumptives  of  Maryland  (1896)  : 

Exclusively  for  white  patients,  preferably  in  the  early 
stages  of  the  disease,  though  under  pressing  circun> 
stances  far  advanced  cases  are  received. 

Capacity:  35. 

Terms:  $3  to  $10  per  week  to  those  able  to  pay;  free  to 
others. 

Resident  Physician :    Harry  S.  Jarrett,  M.  D. 

The  visiting  physicians  are :  Dr.  J.  Miiton  Linthicum, 
Dr.  H;.  Warren  Buckler,  Dr.  W.  \\'ayland  Frames,  Dr. 
A.  Duval  Atkinson. 

Towson  is  in  Baltimore  County,  eight  miles  from  Baltimore,. 
from  which  it  is  reached  by  electric  cars  in  thirty  minutes. 

The  hospital  is  known  as  the  Eudowood  Sanatorium. 
It  is  at  an  altitude  of  500  feet  among  forest-covered  hills. 
There  is  a  large  main  building,  containing  five  private  rooms  and 
tv^ro  wards,  one  for  men  and  the  other  for  women,  one  memorial 
cottage  of  four  rooms  and  another  of  six  rooms,  all  with 
porches  looking  to  the  south  and  west ;  two  or  three  shacks 
and  two  or  three  army  tents.  The  memorial  cottages  were 
built  by  the  daughters  of  Mr.  Theodore  Hopper  in  memory 
of  their  brother  and  by  Mrs.  Nelson  Perin  in  memory  of  her 
husband. 

A  fund  is  being  accumulated  for  the  extension  of  the  hospital 
in  some  favorable  situation  in  the  Blue  Ridge  ]\Iountains,  where 
only  hopeful  cases  are  to  be  received. 

The  hospital  is  supported  by  state  and  city  appropriations^ 
but  chiefly  by  voluntary  contributions.  The  fees  from  patients 
are  inconsiderable. 

The  officers  are :  Dr.  Henry  Barton  Jacobs,  President ;  Rev. 
Arthur  Chilton  Powell  and  Robert  Garrett,  Esq.,  Vice-Presi- 
dents ;  Rev.  A.  Guttmacher,  Secretary ;  David  H.  Carroll, 
Esq.,  Treasurer. 

The  management  of  the  hospital  is  in  the  hands  of  a  Board 
of  Directors  and  a  Board  of  Lady  Managers,  of  whom  Mrs^ 
Thomas  B.  Gambel  is  President. 

Application  for  admission  should  be  made  to  the  Visiting: 
or  the  Resident  Physician. 

51 


MASSACHUSETTS 

MASSACHUSETTS 

Massachusetts  State  Sanatorium  (October,  1898)  : 

Situated  at  Rutland  :  nearest  station,  Muschopauge,  Mas- 
sachusetts Central  Railroad,  a  mile  and  a  half  distant. 

For  earlv  cases  of  pulmonary  tuberculosis ;  patients  must 
be  residents  of  the  state  and  not  too  far  advanced  to 
admit  of  reasonable  hope  of  radical  improvement. 

Capacity :  250. 

Terms :  $4  per  week ;  there  are  no  free  beds,  but  the 
trustees  are  empowered  to  allow  a  few  cases  to  remain 
at  public  expense ;  in  many  cases  the  bills  are  paid  by 
cities  or  charitable  organizations. 

Superintendent :  Walter  J.  Marcley,  M.  D. 

To  Massachusetts  belongs  the  honor  of  having  established 
the  first  state  sanatorium  in  the  country.  It  is  located  near 
the  center  of  the  state,  about  50  miles  from  Boston  and  11 
miles  from  Worcester,  at  an  elevation  of  1,000  feet.  The  build- 
ings are  on  a  southern  slope,  protected  on  the  northwest  by  a 
wooded  hill.  The  pavilions  for  patients  are  one  or  two  stories 
high,  extending  to  the  south,  each  terminating  in  a  solarium 
and  piazza,  and  all  connected  on  the  north  by  a  covered  corridor. 

Dr.  Mncent  Y.  Bowditch  and  Dr.  Herbert  C.  Clapp,  of 
Boston,  have  supervising  charge  of  the  medical  treatment. 
Besides  Dr.  Alarcley  there  are  three  assistant  resident  physicians. 
A  point  of  interest  to  all  who  are  engaged  in  planning  similar 
institutions  is  the  opinion  of  the  superintendent,  after  five  years' 
experience  at  Rutland,  that  open  wards,  containing  from  fifteen 
to  twenty-five  beds,  are  preferable  to  individual  sleeping-rooms. 
Of  the  incipient  cases  discharged  in  the  last  four  years,  73  per 
cent  have  been  arrested  or  apparently  cured. 

The  uniform  charge  of  $4  per  week  covers  less  than  half 
the  actual  expense  for  each  patient.  An  annual  appropriation  is 
m.ade  by  the  legislature ;  the  amount  in  1903  was  $90,000. 

Patients  desiring  admission  to  the  sanatorium  in  Dr.  Bow- 
ditch's  service  may  apply  at  the  Boston  office  of  the  sanatorium 
on  Wednesdays,  or  at  the  sanatorium  in  Rutland  on  Fridays. 

Patients  desiring  to  enter  in  Dr.  Clapp's  service  may  apply 
at  the  Boston  office  of  the  sanatorium  on  Saturdays,  or  at  the 
sanatorium  in  Rutland  on  Mondays. 

53 


MASSACHUSETTS 

The  Boston  office  is  at  the  new  Out-Patient  Department 
of  the  Massachusetts  General  Hospital  on  North  Grove  Street, 
where  examination  of  applicants  is  made  on  Wednesdays  and 
Saturdays  from  1.30  to  3  o'clock  p.  m. 

Examination  of  applicants  is  also  made  at  the  following 
places : 

Worcester,  at  the  Worcester  City  Hospital,  Wednesdays 

and  Saturdays,  9  to  10  a.  m. 
Springiield,  by  Dr.  Everett  A.  Bates,  57  Chestnut  Street, 

Wednesdays  and  Saturdays,  2  to  3  P.  m. 
Pittsfield,  by  Dr.  J.  F.  A.  Adams,  114  Wendell  Avenue, 

Wednesdays  and  Saturdays,  2  to  3  p.  m. 
Fall  River,  by  Dr.  A.  S.  MacKnight,  355  North  Main 

Street,  Wednesdays  and  Saturdays,  2  to  3  p.  m. 
Lowell,   by   Dr.   Boyden  H.   Pillsbury,    58   Kirk    Street, 
Wednesdays  and  Saturdays,  2  to  3  p.  m. 

Any  further  information  will  be  given  by  the  Superintendent, 
Dr.  Walter  J.  Marcley,  Rutland,  Mass. 


54 


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MASSACHUSETTS 

BOSTON, 

Boston  Almshousje;  and  Hospital: 
For  city  charges. 
Resident  Physician :  Simon  F.  Cox,  M.  D. 

Consumptives  are  isolated  from  the  other  patients,  the  men 
in  a  separate  building  accommodating  about  60,  the  women  in 
a  ward  of  the  general  hospital.  Both  places  are  inadequate  to 
the  demand.  Long  Island,  on  which  the  institution  is  situated, 
is  five  miles  from  Boston  and  the  hospital  buildings  are  75  feet 
above  low  water. 

Applications  should  be  made  to  the  Registrar. 


Channing  Homi:,  30  McLean  Street  (1857)  • 

For  women  in  all  stages  of  pulmonary  tuberculosis. 

Capacity:  17. 

All  beds  are  free. 

There  is  no  resident  physician,  but  an  attending  staff  of 

three :  viz.,  William  H.   Smith,  M.  D. ;  Frederick  T. 

Lord,  M.  D. ;  L.  J.  Mead,  M.  D. 

Channing  Home  is  a  light  and  well-ventilated  brick  build- 
ing, four  stories  high,  located  in  the  city  in  a  quiet  street.  It  is 
supported  entirely  by  endowments. 

Applications  for  admission  should  be  made  to  any  of  the 
staff  or  to  the  Matron. 


The:  Cullts  Consumptives'  Home,  Grove  Hall,  New  Dor- 
chester (1864) ' 

For  persons  in  the  last  stages  of  pulmonary  tuberculosis, 
who  are  without  means  of  support  or  friends  able  to 
care  for  them. 

Capacity:  40. 

All  patients  are  cared  for  free  of  charge. 

Medical  Board :  Herbert  C.  Clapp,  M.  D. ;  J.  Tucker  Cut- 
ter, M.  D.;  Samuel  H.  Calderwood,  M.  D. ;  E.  P. 
Ruggles,  M.  D. ;  Percy  G.  Browne,  M.  D. ;  and  two 
internes. 

57 


The  Cullis  Consumptives'  Home. 


MASSACHUSETTS 

The  Consumptives"  Home  is  the  principal  one  of  a  group  of 
charities  founded  in  1864  by  the  late  Dr.  Charles  Cullis,  and 
built  up  and  supported  entirely  by  voluntary  contributions  and 
legacies.  The  building  now  occupied  was  erected  seven  years 
ago.  It  faces  Franklin  Park,  from  which  it  is  separated  by 
Blue  Hill  Avenue  and  a  wide  stretch  of  lawn.  The  grounds, 
consisting-  of  about  six  acres,  are  dry  and  sandy.  On  the  grounds 
ir.  a  small  home  for  children  whose  mothers  are  in  the  Con- 
sumptives' Home. 

Application  should  be  made  to  Rev.  Edward  D.  Alallory, 
Superintendent. 

Free  Home  f'or  Consumptives  in  the  City  oe  Boston, 
428  Ouincy  Street,  Dorchester  (1892)  : 
For  poor  consumptives  in  all  stages  of  the  disease. 
Capacity:  no. 
All  beds  are  free. 

There  is  no  resident  physician,  but  the  list  of  visiting  and 
consulting  physicians  includes  the  names  of  well- 
known  specialists. 

The  Home  is  located  in  the  city  and  patients  are  generally 
in  the  advanced  stages.  It  is  supported  entirely  by  voluntary 
contributions. 

Application  for  admission  should  be  made  to  the  Superin- 
tendent. 

The  House  of  the  Good  Samaritan,  6  McLean  Street 
(1861): 

For  indigent  women  and  children ;  patients  are  received 
in  all  stages  of  tuberculosis,  and  are  partially  separated 
from  the  other  patients. 

Capacity  of  the  hospital :  28  beds,  of  which  6  were  occu- 
pied by  consumptives  on  January  i,  1904. 

All  the  beds  are  free.  The  institution  is  supported  by 
voluntary  contributions. 

There  is  no  physician  in  residence,  but  Dr.  Arthur  K. 
Stone  and  Dr.  Elliott  P.  Joslin  are  the  visiting  phy- 
sicians. 

Application  for  admission  should  be  made  to  the  Matron, 
between  the  hours  of  nine  and  twelve. 

50 


MASSACHUSETTS 


CAMBRIDGE. 

The  Holy  Ghost  Hospital  for  Incurables,  Cambridge 
Street  (1894). 
Advanced  cases  of  tuberculosis  are  received;  in  1903  they 

formed  one-third  of  the  total  number  of  patients. 
There  is  room  for  about  30  tuberculous  patients. 
Terms:   15  free  beds;    $7  per  week  tor  others,  in  wards. 
There  is  no  resident  physician. 

The  grounds  of  this  hospital  adjoin  those  of  Harvard  and 
cover  seven  acres.  The  building  when  completed  will  have  a 
wing  at  each  end,  and  the  whole  structure  will  be  four  stories 
high. 

Applications  should  be  addressed  to  Sister  A.  ]\I.  Purcell, 
Superior. 

EAST  BRIDGEWATER. 

The  ]\[illet  Sanatorium   (Alay,  1900)  : 

Exclusively  for  early  cases  of  pulmonary  tuberculosis. 
Capacity :  20. 

Terms:  $15  to  $30  per  week;    a  limited  number  of  pa- 
tients can  be  received  at  greatly  reduced  rates. 
Medical  Director:  C.  S.  Millet.  M.  D.,  Brockton. 
There  is  no  physician  in  residence. 

The  main  building  is  an  old  colonial  house.  All  the  bed- 
rooms face  south,  and  sleeping  balconies  have  been  added  to 
some  of  them.  Additional  accommodations  are  provided  by 
small  sleeping  shacks  near  the  house.  The  site  is  a  well-drained 
gravelly  hill,  120  feet  above  sea-level.  Special  attention  is  paid 
to  hydrotherapy  in  addition  to  the  usual  methods  of  treating 
tuberculosis. 

Applications  should  be  addressed  to  the  ^lillet  Sanatorium. 


60 


MASSACHUSETTS 


RUTLAND. 

Rutland  Cottages  (April,  1902)  : 

Exclusively  for  early  cases  of  consumption. 

Capacity :  6, 

Terms :  $25  per  week. 

Resident  Physician :  David  P.  Butler,  M.  D. 

Dr.  Butler's  small  private  sanatorium  has  the  same  natural 
advantages  as  the  state  institution  in  the  vicinity.  The  grounds 
extend  over  85  acres  of  woodland  and  pasture.  The  original 
iDuilding,  which  is  soon  to  be  supplemented  by  six-room  cottages, 
is  a  large  two-story  house  with  broad  piazzas  the  entire  length 
of  two  sides.  Special  attention  is  given  to  matters  of  diet  and 
■details  of  out-door  treatment. 

There  are  also  in  Rutland  three  private  houses,  modified  to 
suit  the  need  of  patients,  which  are  directly  under  Dr.  Butler's 
•control.  These  houses  have  accommodations  for  41  patients,  in 
small  wards  containing  from  two  to  six  beds.  One  nurse  in 
each  house  is  employed  by  Dr.  Butler  to  care  for  the  patients. 
The  rates  are  $7,  $7.50  and  $8  per  week,  for  board,  attendance 
and  medical  care. 

Application  should  be  made  to  Dr.  David  P.  Butler,  Rutland, 
or  803  Boylston  Street,  Boston. 


61 


MASSACHUSETTS 


SHARON. 

Thiv  Sharon  Sanatorium  (February,  1891)  : 

For  women  of  limited  means  who  are  in  comparatively 

early  stages  of  pulmonary  tuberculosis ;  not  for  the  far 

advanced. 
Capacity:  21. 

Terms :  $5  per  week,  exclusive  of  laundry. 
Medical  Director:  Vincent  Y.  Bowditch,  M.  D. 
Resident  Physician :  Walter  A.  Griffin,  M.  D. 

Sharon  is  a  most  attractive  town  18  miles  from  Boston,  at 
a  general  elevation  of  350  feet.  The  sanatorium  stands  on  high 
ground,  sheltered  on  the  north  and  northwest  by  thick  woods, 
the  whole  estate  comprising  about  150  acres.  There  is  one 
large  building  facing  south  and  well  supplied  with  piazzas,  an 
infirmary  for  those  who  need  hospital  care,  and  cottages  for  the 
matron  and  physicians.  Payments  from  patients  covered  less 
than  a  third  of  the  actual  expenses  last  year,  the  rest  being  met 
by  voluntary  contributions. 

Application  must  be  made  to  the  Superintendent. 

TEWKESBURY. 

State:  Hospital  (Tuberculosis  Building  opened  in  1900)  : 
Separate  building  for  consumptive  men  who  are  state 

charges ;   all  stages  of  the  disease  are  received. 
Capacity:  100. 
There  are  no  charges. 
Superintendent :  John  H.  Nichols,  M.  D. 

The  hospital  is  situated  in  a  grove  of  white  pines,  on  sandy 
soil,  at  an  elevation  of  135  feet.  The  tuberculosis  building  is 
two  stories  in  height  and  contains  six  wards. 

Admission  is  granted  by  the  Overseers  of  the  Poor, 


62 


MASSACHUSETTS 

WELLESLEY  HILLS. 

Convalescent  Home  of  the  Children's  Hospital  : 
Shack  for  tuberculous  children  (December  26,  1903). 
For  children  who  have  been  under  treatment  for  tvibercu- 

lar  diseases  in  the  Children's  Hospital. 
Capacity:  15. 
Terms :  a  charge  of  $2  per  week  is  made  for  those  who 

are  able  to  pay. 
There   is   no    resident   physician,    but   weekly   visits    are 

made  by  physicians  connected  with  the  Hospital,  and 

Dr.  Bancroft,  of  Wellesley,  is  available  for  emergency 

needs. 

A  wooden  shack  has  been  erected  in  connection  with  the 
Convalescent  Home,  as  an  experiment  in  the  open-air  treatment 
of  children  suffering  from  tubercular  diseases. 

This  shack  is  20  by  40  feet,  and  is  lighted  by  windows  in  the 
roof,  on  each  side,  and  at  both  ends.  The  windows  are  kept 
open  day  and  night,  and  the  sides  of  the  building  are  so  con- 
structed that  they  can  be  opened  two-thirds  of  their  length.  On 
the  southwest  side  the  doors  are  kept  open  all  the  time  in 
moderate  weather. 

Fifteen  children  have  slept  here  every  night  since  the  build- 
ing was  erected,  and  it  is  used  as  a  playroom  in  the  day- 
time by  these  same  children  and  the  fifteen  who  sleep  in  the 
house.  The  shack  is  heated  by  two  "Champion  Railway  Heaters," 
and  the  children  are  warmly  clothed,  both  day  and  night. 

The  cost  of  the  shack  and  the  covered  way  connecting  it 
with  the  house  was  $890. 

It  is  of  interest  that  there  has  not  been  one  case  of  sore 
throat  or  cold  among  the  children.  Their  appetites  improve 
and  they  enjoy  the  out-door  life.  No  children  can  be  received 
except  those  who  are  sent  from  the  Children's  Hospital. 

The  hours  for  application  are : 

For  surgical  cases :  Monday,  Tuesday,  Wednesday  and 

Saturday,  at  2  p.  m. 
For   medical   cases :    Monday,    Tuesday,    Thursday   and 

Saturday,  at  10  a.  m. 

All  applications  must  be  made  at  the  Out-Patient  Department 
of  the  Children's  Hospital,  Huntington  Avenue,  Boston. 

63 


MICHIGAN,  MINNE;S0TA 

MICHIGAN 
State  Sanatorium  : 

Repeated  attempts,  thus  far  fruitless,  to  secure  legislation 
■establishing  a  state  sanatorium,  have  been  made,  and  will  con- 
tinue to  be  made,  by  the  State  Board  of  Health,  the  State  Medi- 
cal Society,  and  individual  physicians. 

ELOISE. 

Tut  Wayne  County  House,  at  Eloise,  which  cares  for  the 
destitute  of  the  county,  erected,  in  September,  1903,  hospital 
tents  for  the  treatment  of  its  consumptive  inmates.  There  is  ac- 
commodation in  the  tents  for  30  patients,  a  larger  number  than 
is  generally  in  the  institution.  There  is  a  resident  physician.  Dr. 
E..  H.  Earle;  Dr.  Shurly,  of  Detroit,  at  whose  suggestion  the 
tent  treatment  was  introduced,  and  Dr.  Marker,  of  Eloise,  are 
the  visiting  physicians. 

All  admissions  are  made  through  the  Wayne  County  Super- 
intendents of  the  Poor. 

MINNESOTA 

State  Sanatorium  for  Consumptives  (to  be  opened  in  1905)  : 

Situated  at  Walker,  Cass  County,  on  the  Great  Northern 
Railroad  and  the  Minnesota  and  International  Railroad. 

For  persons  in  the  early  stages  of  pulmonary  tuberculo- 
sis who  have  been  residents  of  Minnesota  for  at  least 
one  year. 

Capacity :  not  yet  determined. 

Terms :  cost  of  maintenance  to  be  paid  either  by  the 
county  commissioners  or  by  the  patients  themselves. 

There  will  be  a  resident  physician ;  at  present  the  State 
Tuberculosis  Commission  is  in  charge,  of  which  the 
chairman  is  H.  Longstreet  Taylor,  M.  D.,  75  Lowry 
Arcade,  Saint  Paul. 

Seven  hundred  acres,  at  an  altitude  of  1,500  feet  and  about 
250  feet  above  Leech  Lake,  have  been  secured  for  the  site,  and 
an  appropriation  of  $25,000  has  been  made  to  begin  building. 
The  Sanatorium  will  be  owned,  and  supported  in  the  main,  by 
the  state,  but  patients  will  be  required  to  meet  the  actual  cost  of 
their  maintenance. 

Application  should  be  made  to  the  examining  physicians 
who  will  be  appointed  in  each  county. 

61 


MINNESOTA 


SAINT  PAUL, 

Luther  Hospital  Sanatorium    (1903): 

For  early  cases  of  consumption;  advanced  cases  are  ad- 
mitted, but  are  discharged  as  unfit  for  sanatorium, 
treatment  if  they  do  not  soon  begin  to  improve. 

Capacity :   18. 

Terms:  $8  to  $21  per  week. 

The  internes  of  Luther  Hospital  act  as  resident  phy- 
sicians for  the  Sanatorium ;  Dr.  H.  Longstreet  Taylor 
is  the  visiting  physician. 

The  Sanatorium  is  a  separate  building  in  connection  with 
Luther  Hospital.  It  is  a  brick  structure,  three  stories  high,  con- 
taining private  rooms  and  small  wards.  Any  physician  is  at 
liberty  to  place  his  patients  here  and  care  for  them  himself. 
For  poor  patients  the  hospital  charge  is  $8  per  week;  others 
must  pay  for  professional  attendance,  in  addition  to  charges  for 
accommodations.     The  altitude  is  about  800  feet. 

Application  for  admission  should  be  made  to  the  Superin- 
tendent of  Luther  Hospital. 


65 


Luther  Hospital  Sanatorium. 


MISSOURI,   MONTANA. 

MISSOURI 


SAINT  LOUIS. 


]\IouNT    St.    Rose    Sanatorium,    9200    South    Broadway 
(1902)  : 
For  all  stages  of  pulmonary  tuberculosis. 
Capacity  at  present:  65. 
Terms :  $5  to  $25  per  week  for  those  able  to  pay ;   others 

admitted  free  if  there  is  room. 
:^Iedical  Director:  Wilham  Porter,  M.  D.,  3886  Wash- 
ington Boulevard ;   there  is  also  a  resident  physician. 

jMount  St.  Rose  Sanatorium  is  situated  outside  the  city 
boundaries,  on  a  high  site  and  with  25  acres  of  ground.  The 
building  is  new  and  has  50  rooms.  It  is  supported  by  voluntary 
contributions  and  fees  from  patients,  and  is  under  the  super- 
vision of  the  Sisters  of  St.  Mary. 

•  Application  for  admission  should  be  made  to  Mount  St.  Rose 
Sanatorium. 


Emergency  City  Hospitae  No.  2,  Fourteenth  and  O'Fallon 
Streets  (1903)  : 
For  indigent  cases  of  all  kinds  who  are  dependent  on  the 
city.     There  are  two  wards  in  which  tuberculous  pa- 
tients are  isolated. 
Capacity  of  the  tuberculosis  wards :  34. 
There  are  no-  pay  patients. 
Resident  Physician :  John  Young  Brown,  M.  D. 

The  Emergency  City  Hospital  is  located  in  the  heart  of  the 
city.  The  buildings  are  of  brick,  four  stories  high.  New  build- 
mgs  are  in  process  of  erection.     It  is  supported  by  the  city. 

xA.pplication  for  admission  should  be  made  to  the  City  Dis- 
pensary. 

MONTANA 

State  Sanatorium  : 

A  bill  establishing  a  state  sanatorium  has  been  prepared  for 
presentation  to  the  legislature  this  winter. 

67 


NEW  HAAIPSHIRE,  NE:w  JERSEY 

NEW  HAMPSHIRE 

State  Sanatorium  : 

The  establishment  of  a  state  sanatorium  was  recommended 
in  1902  by  the  State  Commission  appointed  to  consider  the 
subject  (see  page  241),  but  the  bill  was  defeated.  Further  at- 
tempts to  secure  its  passage  will  be  made  in  1905. 

PEMBROKE. 

Pembroke  Sanatorium  for  Tuberculosis  (1901)  : 
Exclusively  for  early  cases  of  consumption. 
Capacity:  35. 
Terms:  $15  per  week. 
Resident  Physician;    Henri  T.  Fontaine,  M.  D. 

Pembroke  Sanatorium  is  situated  on  the  southern  slope  of 
Pembroke  Hill,  at  an  altitude  of  600  feet,  overlooking  miles  of 
typical  New  Hampshire  scenery.  It  is  reached  by  the  electric 
railroad  running  from  Concord  to  Manchester.  A  pine  forest 
on  the  north,  east,  and  west  affords  protection  from  the  cold 
winds  of  winter  and  considerably  modifies  the  temperature. 
There  is  an  administration  building,  finished  and  equipped  ac- 
cording to  the  latest  views  of  sanitary  science,  and  17  "camps," 
each  accommodating  two  patients.  These  "camps"  have  hard 
wood  floors  and  are  open  in  front,  provided  only  with  canvas 
curtains  for  protection  when  it  is  necessary.  The  experience 
has  been  that  patients  improve  more  rapidly  here  in  winter  than 
in  summer,  despite  the  cold. 

Application  for  admission  should  be  made  to  Dr.  Henri  T. 
Fontaine,  Concord. 

NEW  JERSEY 

State  Sanatorium  eor  Tuberculous  Diseases  (Projected)  : 
The  site  has  been  secured  at  Glen  Gardner,  Hunterdon 
County,  and  $200,000  was  appropriated  for  buildings  by  the 
legislature  in  the  session  of  1902-3,  but  by  the  omission  of  a  bill 
authorizing  the  disbursement  of  the  appropriation  it  was  not 
available,  and  a  year's  delay  resulted.  In  the  session  of  1904 
the  legislature  again  made  an  appropriation  of  $200,000.  The 
plans  and  specifications  have  received  the  approval  of  the  gov- 
ernor, as  required  by  law,  and  the  work  can  now  proceed.  The 
plans  at  present  provide  for  about  one  hundred  patients. 

68 


NK\V  JERSEY,  NEW   MEXICO 


ORANGE. 


^Memorial  Hospital,  224  Essex  i\veniie   (special  building 
opened  in  1896)  : 
A  general  hospital,  with  a  separate  pavilion  for  all  tuber- 
culosis cases. 
Capacity  of  the  tuberculosis  building:   18. 
For  patients  able  to  pay  the  terms  are  $6  per  week,  but 

most  of  the  care  is  given  free  of  charge. 
There  are  two  resident  physicians  and  a  large  attending 
staff. 

The  tuberculosis  pavilion  contains  two  wards.  Patients  are 
admitted  in  all  stages  of  advancement.  The  hospital  is  endowed 
and  it  receives  an  annual  subsidy  of  $500  from  the  city.  The 
income  from  these  sources  is  supplemented  by  fees  from  patients 
and  by  contributions. 

Applications  for  admission  should  be  made  at  the  office  of 
the  Hospital. 

NEW  MEXICO 

ALBUQUERQUE. 

St.  Joseph  Sanitarium  (May,  1902;  special  building  for 
tuberculosis,  October,  1903)  : 

Not  exclusively  for  the  treatment  of  tuberculous  patients, 
but  the  recently  built  annex  is  reserved  for  their  ac- 
commodation ;   all  stages  of  the  disease  are  received. 

Capacity  of  the  annex  :  40. 

There  are  15  free  beds;  for  other  patients  the  terms  are 
$10  per  week  in  wards,  $15  to  $25  in  private  rooms. 

There  is  no  resident  physician,  but  a  visiting  and  con- 
sulting staff  of  ten. 

The  Sanitarium  is  located  on  a  high  plot  of  ground,  in  the 
outskirts  of  the  city.  In  the  tuberculosis  building  there  are  four 
wards  and  eight  private  rooms.  The  Sisters  of  Charity  of  Cin- 
cinnati are  in  charge  and  the  staff  of  physicians  is  appointed  by 
the  Bernalillo  County  ^Medical  Association. 

Applications  should  be  addressed  to  the  Sister  Superior. 

69 


St.  Anthony's  Sanitarium. 


NEW    MEXICO 


EAST  LAS  VEGAS. 

St.  Anthony's  Sanitarium  (1896)  : 

East  Las  Vegas,  railroad  station  at  Las  Vegas. 

For   all    stages    of   pulmonary    tuberculosis ;     pneumonia 

cases  also  are  admitted. 
Capacity:  35. 

Terms  :  $9  to  $15  per  week. 
There  is  no  resident  physician. 

The  nearest  railroad  station  is  Las  V^egas,  "situated  on  a 
level  and  fertile  prairie,  a  few  miles  from  the  foot  hills  of  the 

Rockies,  the  main  range  of  which  is  in  plain  sight  beyond 

The  altitude  is  6,300  feet  above  the  sea.  .  .  .  There  is  scarcely 
a  spot  on  earth  which  surpasses  the  record  of  Las  Vegas  for 
sunshine." 

The  Sanitarium  was  erected  and  is  still  in  charge  of  the 
Sisters  of  Charity  of  Leavenworth,  Kansas.  It  is  a  three-story 
building,  of  brick  and  stone,  160  feet  in  length,  and  well  sup- 
plied with  broad  verandas.  There  are  no  wards ;  each  guest 
has  a  private  room. 

Application  should  be  made  to  the  Sister  Superior. 


FORT  BAYARD. 

United  States  Generae  Hospital  (1899)  : 

For  tuberculous  soldiers  of  the  United  States  army. 

Capacity:  350. 

There  are  no  charges  for  the  soldiers  sent  here ,  civilians 
pay  from  $5  per  week  to  $1.50  per  day. 

Deputy  Surgeon  General  in  command :  Lt.  Col.  E.  T. 
Comegys;  theie  are  also  four  other  physicians  in  resi- 
dence. 

The  nearest  town  is  Silver  City,  nine  miles  away.  The  alti- 
tude is  over  6,000  feet.  All  admissions  are  under  the  authority 
of  the  War  Department  and  are  made  through  the  Adjutant- 
General  or  the  Surgeon-General  of  the  United  States  Army. 


71 


NEW  MEXICO 

FORT  STANTON,  CAPITAN. 

Public   Health   axd    ]\Iarixe   Hospital   Service    Sana- 
torium (1899)  : 
Exclusively  for  the  ireatment  of  tuberculosis;    admis- 
sion is  g-overncd  by  regulations  of  the  Public  Health 
and  ]\Iarine  Hospital  Service;    eligible  pirsons  are  re- 
ceived in  any  stage  of  the  disease. 
Capacity :  225. 

There  are  no  charges  for  accepted  applicants. 
Surgeon  in  command :  P.  M.  Carrington ;   there  are  also 
in  residence  five  assistant  physicians  and  three  pharma- 
cists. 

This  sanatorium  is  supported  by  the  federal  government  for 
the  benefit  of  seamen  employed  on  the  merchant  marine  vessels 
of  the  United  States,  officers  and  men  of  the  revenue-cutter 
service,  keepers  and  crews  of  light-house  establishments,  and 
seamen  employed  on  vessels  of  some  other  branches  of  the  public 
ser^'ice,  other  than  the  navy.  There  are  more  than  twenty 
buildings  of  various  kinds.  ]\Iost  of  them  are  of  stone  and 
adobe,  and  they  are  arranged  on  four  sides  of  a  square  "Parade 
Ground,'""  which  has  been  converted  into  a  lawn.  More  than 
thirt}-  tents  are  in  use.  The  reservation  contains  38  square 
miles,  nearly  all  enclosed,  and  produces  a  great  variety  of  crops. 
The  altitude  is  6,150  feet. 

Application  should  be  made  to  the  Surgeon-General,  United 
States  Public  Health  and  ^Marine  Hospital  Ser^-ice. 

LAS  CRUCES. 

Las  Cruces  Sanatorium  (September  i,  1904)  : 

Exclusively   for  tubefculosis ;  early  cases  are  preferred, 

but  advanced  ones  also  are  received. 
Capacity :  35-40. 
Terms:  $15  to  $20  per  week;    entrance  examination  fee, 

$5. 
Resident  Physician  :    R.  E.  ]\IcBride.  'M.  D. 

Las  Cruces,  in  the  lower  Rio  Grande  valley,  has  an  elevation 
of  about  3.800  feet.  The  sanatorium  is  a  mile  and  a  half  out  of 
town,  in  the  midst  of  alfalfa  fields.  Its  grounds  include  fifteen 
acres,  well  planted  in  shade  trees.  The  building  is  a  two-story 
adobe,  with  kalsomined  walls  and  hard  wood  floors. 

Application  should  be  made  to  Dr.  R.  E.  ]\IcBride. 

72 


Tents  at  Fort  Stanton. 


NEW    MEXICO 

LAS  VEGAS  HOT  SPRINGS. 

The  Montezuma.        (To  be  opened  January  i,  1905)  : 

Exclusively  for  early  and  moderately  advanced  cases  of 

pulmonary  tuberculosis. 
Capacity :  200. 
Terms  :  $15  per  week  and  upward ;  $7  to  $j2  in  the  Tent 

City  annex. 
Resident  Physician :  J.  W.  Coon,  M.  D. 

The  Las  Vegas  Hot  Springs  Sanatorium  Company  has 
leased  for  its  purposes  the  Montezuma  property,  formerly  a 
hotel.  It  is  located  in  a  canon,  six  miles  from  Las  Vegas,  at  an 
altitude  of  about  6,700  feet,  and  is  sheltered  from  wind  and 
dust  storms  by  the  surrounding  mountains.  The  main  building 
IS  a  four-story  stone  structure  and  there  are  several  cottages  on 
the  grounds.  These  buildings  are  being  remodeled  and  equip- 
ped as  a  modern  sanatorium  for  patients  who  can  pay  at  least 
fifteen  dollars  per  week. 

The  Tent  City  will  be  pitched  on  one  hundred  acres  of  mesa 
land  adjoining  the  Montezuma  grounds,  donated  for  the  purpose 
by  the  town  authorities.  Part  of  this  tract  is  open  and  the  rest 
is  covered  with  pine  trees.  The  object  here  will  be  to  furnish 
good  food  and  medical  attendance  at  the  lowest  possible  cost. 

Application,  until  January,  1905,  should  be  made  to  Dr.  J. 
W.  Coon,  320  Germania  Building,  Milwaukee,  Wisconsin. 


SANTA  FE. 

St.  Vincent  Sanitarium  (1873)  : 

Not  primarily  for  tuberculosis,  but  cases  of  consumption 

are  admitted,  in  whatever  stage  of  advancement. 
There  are  10  free  beds;    others  pay  from  $6  to  $15  per 

week. 
Resident  Physician:  J.  Massie,  M.  D. 

This  institution  is  under  the  management  of  the  Sisters  of 
Charity.  It  receives  its  support  in  part  from  the  territory  and 
in  part  from  patients'  fees.  It  is  located  in  the  central  part  of 
the  town. 

Application  should  be  made  to  the  Sister  Superior. 

75 


ne;w  MEXICO 


SILVER  CITY. 

St.  Joseph's  Sanatorium  (October,  1901)  : 

For  such  cases  of  pulmonary  tuberculosis  as,  in  the  opin- 
ion of  some  reputable  physician,  present  a  fair  prospect 
of  recovery. 

Capacity :  50. 

Terms  :  $100  per  month. 

Medical  Director,  in  residence:  E.  S.  Bullock,  M.  D., 
formerly  pathologist  and  physical  diagnostician  at  the 
United  States  General  Hospital  for  Tuberculosis. 

Silver  City  is  only  nine  miles  from  Fort  Bayard,  which  was 
chosen  by  the  United  States  Government  authorities  as  offering 
the  greatest  climatic  advantages  for  the  treatment  of  tuberculo- 
sis. The  altitude  is  6,000  feet;  the  average  annual  rainfall, 
12.3  inches;  the  average  number  of  cloudy  days  in  the  year,  37. 
It  is  at  the  terminus  of  a  branch  of  the  Atchison,  Topeka  and 
Santa  Fe  Railroad. 

The  Sanatorium  is  located  "outside  the  business  center  of 
Silver  City,  on  rising  ground,  protected  by  hills  from  the  pre- 
vailing north  and  west  winds,  and  overlooking  the  little  town 
and  a  wide  range  of  outlying  country.  .  .  .  The  buildings  are 
old  California  Mission  in  style,  built  around  a  court.  .  .  .  The 
older  building  is  used  as  an  infirmary  for  patients  requiring 
special  care,  and  composes  one  side  of  the  square.  The  new 
structure  ...  is  really  a  succession  of  cottages,  possessing  all 
the  advantages  and  none  of  the  disadvantages  of  the  cottage 
system.  Each  room  is  heated  by  a  fire-place,  thus  insuring  addi- 
tional ventilation.  ...  A  room  devoted  to  hydropathy  has  been 
provided  in  the  main  building.  .  .  .  The  principles  which  gov- 
ern the  care  and  treatment  of  patients  are,  with  few  modifica- 
tions, those  laid  down  by  the  Brehmer  school." 

The  Sisters  of  ]\Iercy  are  in  charge  of  the  business  manage- 
ment of  the  institution,  but  all  medical  matters  are  imder  the 
control  of  the  medical  director  and  his  advisors. 

Applications  should  be  addressed  to  Dr.  E.  S.  Bullock,  Medi- 
cal Director. 


76 


St.  Joseph's  Sanatorium. 


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The  Court,  St.  Joseph's  Sanatorium. 


NKW   YORK: 

NEW  YORK 

State:  Hospital  for  the  Treatment  oe  Incipient  Pul- 
monary Tuberculosis  (July  i,  1904),  situated  at 
Ray  Brook,  Essex  County: 
Primarily  for  the  poor,  but  pay  patients  will  be  received 
when  there  is  room  for  them;  one  year's  residence  in 
this  state  is  a  required  condition.     Incipient  cases  only 
are  admitted. 
Capacity :   120. 

By  a  provision  of  its  charter  the  Hospital  is  required  to 
give  preference  to  the  indigent,  admitting  others  only 
when  vacancies  occur.  The  authorities  by  whom  the 
patient  is  sent  are  required  to  pay  transportation  to  and 
from  the  Hospital  and  $5  per  week  for  maintenance. 
Physician  in  charge :  John  H.  Pryor,  M.  D. 

The  State  Hospital  is  located  in  the  Adirondacks,  four  miles 
southeast  of  Saranac  Lake  and  six  miles  west  of  Lake  Placid. 
There  is  an  administration  building,  with  a  pavilion  on  each 
side,  connected  with  the  central  building  by  wings  to  be  used 
as  sun  rooms.  The  516  acres  of  land  adjoin  the  Forest  Preserve. 
The  altitude  is  1,625  feet. 

The  examining  physicians  are  as  follows : 

Albany :  Drs.  S.  B.  Ward,  George  E.  Gorham. 

Amsterdam:  Drs.  Chas.  Stover,  H.  M.  Hicks. 

Auburn :  Drs.  W.  S.  Cheesman,  Chas.  A.  Gwynn. 

Binghamton :  Drs.  Daniel  S.  Burr,  L.  A.  Martin. 

Buffalo :  Drs.  H.  R.  Hopkins,  Chas.  S.  Jewett,  B.  J.  May- 
cock,  G.  T.  Moseley. 

Cohoes:  Dr.  Jas.  H.  Mitchell. 

Corning:  Dr.  WilHs  S.  Cobb. 

Cortland :  Dr.  E.  M.  Santee. 

Dunkirk :  Dr.  Joseph  Rieger. 

Elmira :  Drs.  W.  D.  Wey,  F.  W.  Adriance. 

Fulton :  Drs.  Chas.  J.  Bacon,  N.  H.  Haviland. 

Geneva :  Drs.  W.  W.  Skinner,  N.  B.  Covert. 

Gloversville :  Drs.  Eugene  Beach,  W.  S.  Garnsey. 

Hornellsville :  Drs.  Jas.  E.  Walker,  W.  E.  Hathaway. 

Hudson :  Drs.  Thos.  Wilson,  C.  P.  Cook. 

Ithaca :  Drs.  Chauncy  P.  Biggs,  Martin  Bessmer, 

Jamestown :  Drs.  Wm.  M.  Bemus,  J,  W.  Scott. 


Tents  at  Ray  Brook. 


NEW  YORK 

Johnstown :  Drs.  D.  V.  Still,  C.  B.  Walclrad. 

Kingston :  Dr.  G.  H.  Van  Gaasbeek. 

Little  Falls :  Dr.  A.  B.  Santry. 

Lockport:  Dr.  S.  Wright  Hurd. 

Mt,  Vernon :  Drs.  E.  F.  Brush,  N.  H.  Ives. 

Newburgh :  Dr.  F.  A.  Jacobson. 

New  Rochelle:  Dr.  D.  J.  Roberts. 

New  York:  Drs.  Hermann  M.  Biggs,  Egbert  Le  Fevre, 
Geo.  F.  Eaidlaw,  Wm.  H.  Vandenburg. 

Niagara  Falls :  Drs.  W.  R.  Campbell,  W.  H.  Hodge. 

North  Tonawanda:  Drs.  H.  C.  Leonhardt,  F.  W.  Bent- 
ley. 

Ogdensburg:  Drs.  W.  Grant  Cooper,  Willard  N.  Bell. 

Olean :  Drs.  Caesar  Smith,  D.  M.  Hibbard. 

Oneida:  Dr.  A.  P.  Dodge. 

Oswego:  Dr.  M.  E.  Page. 

Plattsburgh :  Drs.  W.  S.  Buck,  Floyd  S.  Farnsworth. 

Poughkeepsie :  Drs.  R.  W.  Andrews,  Chas.  E.  Lane. 

Rensselear :  Drs.  J.  C.  Sharkey,  E.  PL  Humphrey. 

Rochester :  Drs.  W.  S.  Ely,  Myron  H.  Adams. 

Rome:  Dr.  T.  P.  Scully. 

Schenectady :  Drs.  Wm.  L.  Pearson,  W.  P.  Faust. 

Syracuse:  Drs.  Henry  L.  Eisner,  J.  Willis  Candee. 

Troy :  Drs.  R.  H.  Irish,  H.  L.  Waldo. 

Utica :  Drs.  Wm.  M.  Gibson,  F.  F.  Laird. 

Watertown :  Dr.  E.  S.  Willard. 

Watervliet :  Dr.  L.  B.  Rulison. 

Yonkers:  Dr.  H.  G.  Keith. 
Application  should  be  made  to  the  nearest  public  authorities 
having  charge  of  the  relief  of  the  poor. 


81 


Springside  Sanitarium. 


NEW  YORK 


AUBURN. 

Springside  Sanitarium   (June,  1904)  : 

Exclusively  for  the  treatment  of  pulmonary  tuberculosis; 

early  cases  are  preferred. 
Capacity:  15. 

Terms:  $15  to  $25  per  week. 
Resident  Physician :  Nettie  E.  Jenkins,  M.  D. 

This  small  private  sanatorium  is  situated  about  i  000  feet 
above  sea  level,  on  a  dry  sand  hill  overlooking  Owasco  Lake. 
The  main  building-  is  a  large  three-story  frame  house  in  the 
midst  of  pine  woods.  Each  room  has  four  or  five  windows  and 
an  open  grate.  On  the  western  side  of  the  house  there  is  a 
.screen-enclosed  veranda  for  sleeping  purposes.  In  addition  to 
the  main  building  there  is  a  cottage  on  the  summit  of  the  hill. 

Applications  should  be  addressed  to  Dr.  N.  E.  Jenkins. 


83 


NEW   YORK 


BEDFORD  STATION,  Westchester  County. 

Monte^Fiore;  Country  Sanitarium  (1897)  : 

Exclusively  for  poor  consumptives  in  the  early  stages  of 

the  disease. 
Capacity:  162;  during  the  summer  and  fall,  166,  by  the 

use  of  tents  for  sleeping. 
There  are  no  charges. 
Medical  Superintendent :  L.  Rosenberg,  M.  D. 

The  main  building  of  the  Country  Sanitarium,  situated  on 
a  farm  of  160  acres  at  an  altitude  of  450  feet,  is  formed  of  four 
wings,  connected  by  glass-covered  corridors.  The  distinctive 
feature  of  the  treatment  here  is  the  out-door  employment  given 
to  selected  cases  of  incipient  and  convalescent  pulmonary  tuber- 
culosis. "During  the  spring,  summer,  and  autumn,"  to  quote 
from  the  report  of  Dr.  Alfred  Meyer,  the  consulting  physician, 
"this  work  has  been  largely  in  farm,  garden  and  orchard.  The 
produce  and  supplies  raised  were  far  beyond  the  needs  of  the 
institution,  and  the  prize  pumpkins,  cabbages,  radishes,  and 
ears  of  corn  would  have  done  credit  to  a  country  fair.  The 
value  of  such  a  regime  to  the  patients  themselves  is  simply 
inestimable.  The  out-door  life  it  encourages,  the  training  in  a 
useful  and  healthful  occupation,  the  stimulus  that  comes  with 
something  accomplished,  the  reduction  of  the  hours  of  loafing 
and  brooding,  all  tend  to  the  betterment  of  the  patient,,  both 
physical  and  moral."  Last  year  the  average  time  spent  in  work 
by  the  patients  for  whom  it  was  recommended  was  two  and  a 
half  hours  a  day  and  the  average  number  of  patients  at  work 
was  twenty-five.  A  school  has  been  organized  for  the  children 
and  young  people. 

Application  should  be  made  to  the  Superintendent  of  Monte- 
fiore  Home,  Broadway  and  138th  Street,  New  York  City. 


8i 


NEW   YORK 


BROOKLYN. 

Brooklyn    Home    i?or    Consumptives,    Kingston   Avenue 
(1881): 
For  poor  consumptives  of  Brooklyn,  without  distinction 
of  color  or  nationality,  in  whatever  stage  of  the  disease 
they  may  be. 
Capacity:  115.  _^,^':   ■ 

There  are  no  charges.  ,  *^" 

No  physician  is  in  residence. 

This  institution  is  a  large  building  pleasantly  located  in  the 
city.  From  the  beginning  of  its  work,  over  twenty  years  ago, 
patients  in  an  apparently  hopeless  condition  have  not  been  re- 
fused. Frequently,  however,  a  cure  has  been  effected  in  spite 
of  all  the  probabilities  against  it.  The  income  is  derived  from 
mterest  on  endowments,  voluntary  contributions  and  a  city 
appropriation. 

Application  for  admission  should  be  made  to  Mrs.  Sophia  S. 
Boggs,  Chairman  of  the  Committee  on  Application,  178  Clinton 
Street,  Brooklyn. 

Kings  County  Hospital,  Clarkson  Street  (1898)  : 
For  the  destitute  sick  of  Kings  County. 
There  is  a  separate  pavilion  for  patients  suffering  from 

pulmonary  and  laryngeal  tuberculosis.     All  stages  are 

received. 
Capacity  of  pavilion  for  consumptives :  65. 
There  are  no  charges. 
Resident  Physician :  F.  W.  Smith,  M.  D. 

The  building  for  consumptives  is  of  brick,  three  stories  high, 
fireproof,  with  baths,  sun  rooms,  and  dormitories  on  each  floor. 
The  hospital  is  a  city  institution. 

Application  should  be  made  to  the  Department  of  Public 
Charities,    126-128  Livingston   Street,   Brooklyn. 


85 


NEW   YORK 


St.  Peter's  Hospital^  Henry,  Congress  and  Warren  Streets : 

A  general  hospital,  but  five  wards  are  reserved  for  con- 
sumptive patients. 

Capacity  of  consumptive  wards  :  75. 

There  are  no  charges. 

Ph3'sicians  in  charge  for  November  and  December,  1904: 
Drs.  T.  P.  Corbally,  T.  A.  McGoldrick,  A.  A.  Rutz  and 
P.  J.  York;  there  are  always  four  physicians  in  charge, 
serving  for  terms  of  two  months. 

Tuberculous  patients  are  received  in  all  stages  of  the  disease 
and  are  treated  in  separate  wards.  The  capacity  of  these  wards 
is  about  one-sixth  the  total  capacity  o£  the  hospital.  The  hospital 
is  under  the  charge  of  the  Sisters  of  the  Poor  of  St.  Francis. 

Applications  for  admission  should  be  made  to  the  Sisters 
between  9  and  12  a.  m.  and  3  and  5  p.  m. 


8G 


NHW   YORK 


BUFFALO* 

Erii:  County  Consumption  HospitaIv  (1902)  : 
For  indigent  consumptives  of  Erie  County. 
Capacity :  54. 
Resident  Physician :  E.  J.  Gilray,  M.  D, 

The  Poor  Farm,  on  which  this  hospital  is  situated,  consists 
of  156  acres  just  within  the  city  Hmits,  at  an  altitude  of  about 
600  feet.  The  building  for  consumptives  is  an  isolated  one  of 
stone,  connected  with  the  main  hospital  by  corridors,  and  con- 
taining six  wards,  four  single  rooms,  and  four  sun  rooms.  It 
is  supported  jointly  by  the  City  of  Buffalo  and  by  Erie  County. 

Application  for  admission  should  be  made  to  the  Superin- 
tendent of  the  Poor,  Buffalo. 


EAST  VIEW. 

We;stchestkr  County  Hospital,    (Pavilion  for  consump- 
tives, 1904)  : 
The  hospital  is  for  the  care  of  the  poor  of  Westchester 
County,   whatever   their   disease;    cases    of   contagion 
only  are  excluded.     A  brick  building  cc'ntaining  two 
general  wards,  three  isolation  rooms,  and  sun  parlors, 
has  just  been  erected,  for  the  separation  of  the  tuber- 
culous patients. 
Capacity  of  the  new  building:  24. 
House  Physician :  Fred  Baker,  M.  D. 
All  the  beds  are  free  to  persons  committed  by  the  Poor  Mas- 
ter or  Commissioner  of  Charities.     In  case  of  vacancies  pay  pa- 
tients will  be  received  at  the  rate  of  $7  per  week. 

Application  for  admission  should  be  made  to  the  Superin- 
tendent of  the  Poor  of  Westchester  County. 


87 


NEW   YORK 


LAKE  KUSHAQUA. 

Stony  Woi.d  Sanatorium  (October,  1903)  : 

For  women  and  children  in  the  early  stages  of  tuber- 
culosis who  are  not  able  to  pay  in  full  for  treatment  at 
at  a  sanatorium. 
Capacity :  at  present,  70 ;  the  plans  contemplate  room  for 

150. 
Terms  :  $7  per  week. 
•    Medical    Board :    Drs.    E.    G.    Janeway,    G.    F.    Shrady, 

Francis  Delafield,  Charles  H.  Knight,  CM.  Cauld- 

well  and  James   E.   Newcomb,   of   New   York;   Drs. 

Henry  Hun  and  Arthur  G.  Root,  of  Albany. 
The  architect's  plans  contemplate  two  long  dormitories  on 
each  side  of  an  administration  building.  At  present  the  central 
building,  containing  offices,  dining-room,  assembly  rooms,  and 
apartments  for  the  resident  staff,  is  completed,  and  two  of  the 
dormitories.  In  each  dormitory  there  are  twenty-five  bedrooms, 
a  sitting-room,  a  sun  parlor,  nurses'  apartments,  diet  kitchen 
and  bathrooms.  The  location  is  near  the  lake,  among  the  pine 
woods.  Instruction  in  the  ordinary  school  branches  is  provided 
for  the  children.  The  funds  for  building  and  maintenance  are 
derived  entirely  from  voluntary  contributions.  Lake  Kushaqua 
is  in  Franklin  County,  nine  miles  from  Paul  Smith's,  on  the 
Adirondack  Division  of  the  New  York  Central  and  Hudson 
River  Railroad. 

Applications  should  be  addressed  to  Mrs.  James  E.   New 
comb,  President,  118  West  69th  Street,  New  York  City. 


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NlCW    YORK 


LIBERTY,  Sullivan  County. 

LvOOMis  Sanatorium   (1896)  : 

Exclusively  for  the  treatment  of  tuberculosis. 

Capacity :  100  in  the  cottages ;  40  in  the  Annex. 

Terms :  in  the  Annex,  $5  per  week ;  in  the  cottages,  $10 

to  $35  per  week ;  there  are  14  supported  beds. 
Physician  in  Chief:  Herbert  Maxon  King,  M.  D. ;  there 

are  three  assistants,  who  are  also  in  residence  at  the 

sanatorium. 

Two  miles  from  the  village  of  Liberty,  on  the  southern  slope 
of  a  range  of  hills,  at  an  altitude  of  2,300  feet,  are  located  the 
buildings  which  constitute  Loomis  Sanatorium.  The  adminis- 
tration building  is  of  stone  and  half  timber,  heated  by  steam 
and  hot  water,  lighted  by  electricity,  and  containing,  besides 
the  offices,  reception  rooms,  and  dining  hall,  a  laboratory 
and  a  number  of  rooms  equipped  for  different  kinds  of  treat- 
ment. There  is  an  infirmary  for  the  treatment  of  patients  more 
advanced  with  the  disease  or  temporarily  confined  to  bed.  The 
patients  are  housed  in  fourteen  cottages,  of  varying  size, 
scattered  over  the  grounds.  There  are  several  cottages  adapted 
for  independent  housekeeping,  which  may  be  taken  by  a  patient 
and  his  family,  enabling  them  thus  to  live  apart  while  at  the  same 
time  under  sanatorium  care  and  regime.  A  casino,  a  library, 
and  a  chapel,  complete  the  group  of  buildings. 

Applications  should  be  addressed  to  Dr.  Herbert  Maxon 
King,  Physician  in  Chief. 


91 


Lean  To  "  at  the  Annex,  Liberty. 


Interior  of  "Lean  To." 


Xi;w   YORK 

NEW  YORK  CITY. 

TuBERCUivOSis  Ixfir:mary  oi^  thi;  ^Metropolitan  HospitaIv^ 
D^PARTMEXT  OE  PuEEic  CHARITIES  (^January, 
1902)  : 

For  the  consumptives  of  Xew  York  City  who  are  with- 
out resources  to  procure  suitable  private  treatment; 
all  stages  of  the  disease  are  received,  and  the  advanced 
cases  isolated. 

Capacity :  450. 

There  is  no  provision  for  pay  patients. 

Chief  of  Resident  Staff:  J.  B.  Mickle,  ^L  D. 

The  history  of  the  Tuberculosis  Infirmary  on  Blackwell's 
Island  is  of  sufficient  interest  to  justify  the  following  quotations 
from  the  Annual  Report  of  the  Department  of  Public  Charities 
of  the  City  of  New  York,  for  the  year  1902 : 

"On  January  i,  1902,  there  was  no  hospital  set  apart  for 
consumptives  in  the  Department,  though  there  were  318  con- 
simiptive  patients  in  Bellevue,  City,  ^Metropolitan  and  Almshouse 
Hospitals,  of  Avhom  155  were  distributed  through  wards  occupied 
by  other  patients,  while  163  were  in  wards  devoted  to  this 
disease,  but  in  the  same  buildings  as  wards  occupied  by  other 
patients.  On  Blackwell's  Island,  near  the  ^Metropolitan  Hospital, 
there  were  three  buildings  formerly  occupied  by  the  Man- 
hattan State  Hospital  for  the  Insane,  but  vacated  by  that 
hospital  in  October,  1901.  On  January  31,  1902,  one  of  these 
buildings  was  opened  as  a  hospital  for  consumptives,  and  within 
a  week  all  consumptive  patients  not  in  wards  set  apart  exclu- 
sively for  consumptives  were  transferred  from  Bellevue,  Cit}' 
and  ]\Ietropolitan  Hospitals  to  this  new  hospital.  A  second 
building  was  subsequently  put  in  order  by  this  Department 
through  its  own  labor,  the  bars  being  removed  from  the  win- 
dows, the  gratings  removed  from  over  the  doors,  the  walls 
painted,  new  floors  laid  and  the  buildings  otherwise  made  fit  for 
habitation,  and  as  rapidly  as  the  buildings  could  be  put  in  order 
the  phthisis  patients  were  removed  from  the  former  phthisis 
vv-ards  in  the  Metropolitan  main  building  and  at  the  Almshouse. 
All  phthisis  patients  received  by  the  Department  subsequent  to 
the  opening  of  this  hospital  were  sent  there  directly." 

"The  Deputy  Superintendent  of  the  2\Ietropolitan  Hospital 
was  .  .  .  assigned  to  the  Tuberculosis  Infirmary,  with  instruc- 
tions to  give  special  attention  to  personal  acquaintance  with  the 

94 


NEW   YORK 

patients  and  to  the  social  life  of  the  institution,  and  also  study 
the  sociological  aspects  of  the  tuberculosis  problem." 

The  building  for  women  has  room  for  90  patients.  The 
men's  building  is  much  larger  and  consists  of  wide,  light  halls 
with  rooms  for  one  and  two  beds  opening  off  them.  There  are 
no  doors  between  the  rooms  and  the  corridors,  and  the  free 
circulation  of  air  is  thus  unhindered.  Tent  cottages  provide  for 
125  men  and  25  women.  They  weie  in  use  all  through  last 
winter.  Patients  who  are  able  to  work,  generally  about  one- 
third  of  all,  are  assigned  some  definite  duty.  Recently  a  solarium 
has  been  added  to  the  equipment. 

Application  should  be  made  to  the  Superintendent,  Bureau 
of  Dependent  Adults,  foot  of  East  26th  Street. 

RiVE^RSiDEi  Sanatorium  i^or  Pulmonary  Dise:ase;s  (1903)  : 
For  poor  consumptives  of  New  York  City  in  any  stage  of 

pulmonary  tuberculosis. 
Capacity :    68. 
There  are  no  charges. 
Resident  Physician :  Samuel  T.  Watson,  M.  D. 

The  Riverside  Sanatorium  is  located  on  North  Brother 
Island,  East  River,  in  three  one-story  pavilions  divided  into 
two  or  more  wards.  It  is  supported  by  the  city,  and  is  under 
the  direct  management  of  the  Department  of  Health. 

Application  for  admission  should  be  made  to  the  Depart- 
ment of  Health,  55th  Street  and  Sixth  Avenue. 

Se;ton  Hospital,  Spuyten  Duyvil  Parkway  (1895)  : 

For  all  stages  of  pulmonary  tuberculosis,  and  for  other 
forms  of  tuberculosis  in  children. 

Capacity :  in  Seton  proper,  200  men ;  in  new  annex, 
Nazareth,  150  women  and  children. 

The  wards  of  the  hospital  are  generally  kept  filled  with 
patients  dependent  on  the  Department  of  Public  Chari- 
ties, and  the  cost  of  their  treatment  is  met  by  the  city. 
There  are  also  25  or  30  private  rooms  for  persons  able 
to  pay  from  $10  to  $20  per  week. 

Resident  Physician :  B.  B.  Steedly,  M.  D. 

The  site  is  an  eminence  of  about  200  feet  elevation  over- 
looking the  Hudson.     The  buildings   are  of  modern  type  in 

95 


NEW  YORK 

regard  to  sanitation  and  ventilation.  A  maximum  amount  of 
sunlight  and  fresh  air  is  available  both  in  wards  and  in  private 
rooms.  The  institution  is  in  charge  of  the  Sisters  of  Charity. 
There  are  two  resident  physicians,  and  a  number  of  the  specialists 
of  the  city  are  on  the  visiting  and  consulting  staff.  The  chief 
source  of  income  is  the  fees  paid  by  the  city,  but  the  institution 
receives  some  funds  also  from  private  patients,  voluntary  con- 
tributions and  endowments. 

Private  patients  should  apply  directly  to  the  Superintendent 
of  the  Hospital;  by  others  appHcation  should  be  made  to  the 
Superintendent,  Bureau  of  Dependent  Adults,  foot  of  East  26th 
Street. 

St.  Joseph's  Hospital  eor  Consumptr'ES,  St.  Ann's  Ave- 
nue and  143d  Street  (1882)  : 
For   poor   consumptives,    irrespective    of   nationality    or 

religion;    patients  in  all  stages  are   received,  but  the 

majority  are  advanced  cases. 
Capacity :  300. 
There  are  280  free  beds;  the  charge  in  private  wards  is 

$5  per  week;  in  private  rooms,  $10. 
Physician  in  Chief :  Charles  :\I.  Cauldwell,  M.  D. 
Physician  in  Charge :  Henry  A\'ollner,  ]M.  D. 
Consulting   Physicians :   Drs.   John  Doming  and   Frank 

E.  Miller. 
Visiting  Physicians  :  Drs.  H.  L.  Shively,  A.  Spence,  J.  H. 

Larkin,  E.  AA'.  Perkins,  J.  L.  Dinning,  A.  Muller,  F. 

H.   Dillingham,  T.   H.   Curtin,  '].   B.   Mannmg,  J.  J. 

Morrissey,  C.  E.  Banker,  A.  R.  Braunlich  and  J.  F. 

Holmes. 
Visiting  Surgeons :  Drs.  W.  J.  Furness,  M.  J.  Schwerd, 

C.  H.  :\lcllwaine. 

This  institution  covers  the  entire  block  between  St.  Ann's 
and  Brook  Avenue  and  143d  and  144th  Streets.  It  is  owned 
and  conducted  by  the  Roman  Catholic  order  of  The  Sisters  of 
the  Poor  of  St.  Francis.  There  is  a  garden  attached  to  the 
grounds.  The  main  building  is  a  four-stor\-  structure,  facing 
south,  with  east  and  west  wings.  It  is  lighted  by  gas  and  heated 
by  steam  radiators.  The  ground  floor  is  divided  into  waiting- 
rooms,  sitting-rooms,  offices,  examining-rooms  and  small  wards. 
The  three  upper  stories  are  each  divided  into  five  large  wards, 

96 


N^W   YORK 

five  small  wards  and  a  few  single  rooms.  The  chapel  occupies 
a  separate  extension.  In  the  rear  of  the  main  building,  but 
separated  from  it,  is  a  house  devoted  to  the  use  of  incipient  and 
arrested  cases  of  consumption.  An  average  of  1,500  patients 
i.--  treated  each  year.  Apart  from  the  individual  good  which 
these  consumptives  may  derive  from  hospital  care  the  public 
at  large  is  benefited  by  the  removal  of  the  invalids  to  a  place 
where  they  cease  to  be  centers  of  infection,  and  where  they  no 
longer  hamper  the  wage-earning  capacity  of  the  remaining- 
members  of  their  families. 

(This  paragraph  is  substantially  a  quotation  from  Dr.  S.  A. 
Knopf's  Prophylaxis  and  Treatment  of  Pulmonary  Tuberculosis, 
p.  160.) 

The  institution  is  supported  by  voluntary  contributions  and 
appropriations  from  the  city. 

Application  should  be  made  to  the  Sister  Superior. 

The:  Home  for  Incurabi,es,  occupying  an  entire  block  at 
Third  Avenue  and  i8ist  Street: 
Receives  a  few  consumptives  in  single  rooms. 
Not  more  than  12  can  be  accommodated  at  one  time,  and 

the  usual  proportion  is  about  6  out  of  250  patients. 
The  rates  are  $10  per  week  and  up,  in  single  rooms. 

Applications  should  be  addressed  to  Israel  C.  Jones,  M.  D.. 
Medical    Superintendent. 

The  House  of  Rest  for  Consumptives,  Bolton  Road  and 
209th  Street  (1869)  : 
Chiefly  for  advanced  cases  of  consumption. 
Capacity :  39. 
There  are  no  charges,  the  institution  being  supported  by 

endowments  and  voluntary  contributions. 
There  is  no  resident  physician. 

For  ten  years  previous  to  January,  1902,  the  House  of  Rest 
arranged  for  its  beneficiaries  to  be  cared  for  at  St.  Luke's  Hospi- 
tal. At  that  time  the  estates  at  Inwood  were  purchased  and  the 
necessary  alterations  begun.  The  primary  object  is  to  provide 
a  refuge  for  incurable  consumptives,  but  hopeful  cases  are  not 
excluded. 

Application  should  be  made  to  George  F.  Sauer.  Super- 
intendent. 

97 


NEW  YORK 

Lincoln  Hospital  and  Home;,  East  141st  Street  and  South- 
ern Boulevard  (1839)  • 
A  general  hospital,  with  separate  provision  for  about  40 

consumptives   in  wards   and  private  rooms ;   patients 

are  received  in  all  stages  of  pulmonar)^  tuberculosis. 
Terms :  for  those  able  to  pay,  $1  per  day  in  the  wards, 

and   from   $15   to   $35    per   week   in   private   rooms; 

man)^  free  patients  are  accepted  who  are  sent  by  the 

Department  of  Public  Charities, 
The  resident  staff  consists  of  six  physicians. 

This  institution  was  originally  a  Colored  Home,  with  an  at- 
tached hospital,  chiefly  for  chronic  cases.  About  two  years  ago 
it  was  changed  to  a  general  hospital,  for  both  white  and  colored. 
The  buildings  occupy  an  entire  block  on  high  ground  in  the 
Bronx,  overlooking  the  East  River  and  Long  Island  Sound. 

AppHcations  should  be  made  between  8  A.  M.  and  6  P.  M., 
at  the  office  of  the  Superintendent. 

MoNT:eFiORE  HoiMi;  for  Chronic  Invalids,  Broadway  and 
138th  Street  (188/1)  : 
One  ward  is  reserved  for  patients  in  advanced  stages  of 

consumption  who  are  unable  to  pay  for  treatment. 
Capacity  of  the  consumptive  ward:  40. 
There  are  no  charges. 

Superintendent:  A.  Haussman;  there  are  four  resident 
physicians. 

Montefiore  Home  occupies  an  entire  block  in  the  northwest- 
ern part  of  the  city,  near  the  Hudson  River,  and  not  as  yet 
crowded  with  high  buildings.  This,  and  the  Country  Home  at 
Bedford  Station,  are  charities  supported  by  the  Jewish  philan- 
thropists of  the  city. 

Application  for  admission  should  be  made  to  the  Super- 
intendent. 


98 


Ni;w   YORK 

SiiASiDi:  TjiNT-  Camp  for  children  suffering  from  tuberculosis 
in  bones  and  glands  (June,  1904)  : 
For  children  from  three  to  ten  years  of  age,  suffering 

from  non-pulmonary  tuberculosis. 
Capacity :  54. 
There  are  no  charges. 
Resident  Physician :  M.  Burnham,  M.  D. 

This  experimental  sanatorium,  the  first  of  its  kind  in' 
America,  was  established  and  is  maintained  by  the  New  York 
Association  for  Improving  the  Condition  of  the  Poor.  It  is 
located  on  the  Coney  Island  shore,  at  Surf  Avenue  and  Thirty- 
lirst  Street,  just  west  of  Sea  Breeze,  the  Association's  fresh-air 
home,  and  is  sufficiently  far  removed  from  the  amusement  halls 
and  gaieties  to  be  undisturbed  by  the  noise  of  the  usual  Coney 
Island  crowd.  The  tent  camp  consists  of  ten  rectangular  tents 
with  wooden  floors,  raised  a  sufficient  distance  above  the  ground 
to  allow  ventilation  and  prevent  dampness. 

Eight  of  the  tents  are  arranged  in  the  figure  of  an  octagon, 
with  a  board  walk  connecting  them,  enclosing  a  playground  of 
sand  some  thirty  feet  wide.  Four  of  these  tents  are  accommodat- 
ing fifty  children,  one  is  for  nurses  and  administration,  one  with 
open  sides  is  a  playroom,  and  one  is  used  for  a  dining-room. 
The  dining  tent  is  connected  with  a  small,  single-storied, 
wooden  structure,  used  in  part  for  a  kitchen  and  pantry,  and  in 
part  for  a  wash-room  for  the  children.  In  this  building  there 
is  also  a  small  room  utilized  for  dressing  abscesses  and  wounds 
resulting  from  necessary  operative  treatment.  Two  smaller 
tents,  situated  at  a  little  distance,  are  used,  one  for  attendants 
and  one  as  an  isolation  ward. 

The  scope  of  the  hospital  is  limited  to  the  treatment  of  non- 
pulmonary  tuberculosis  in  children  from  three  to  ten  years  of 
age.  It  is  not  expected  to  carry  out  major  surgical  operations, 
such  as  are  often  necessary  in  some  forms  of  tuberculosis,  nor 
is  it  feasible  to  make  all  the  appliances  necessary  for  the  treat- 
ment of  joint  and  spinal  cases.  It  is  rather  intended  to  prevent 
the  use  of  the  surgeon's  knife  and  to  hasten  convalescence  when 
operations  have  been  necessary,  and  to  prove  to  the  community 
that  hygienic  means  may  avail  in  some  cases  which  otherwise 
would  be  relegated  to  the  surgeon  or  considered  hopeless.     A 

99 


NE;w   YORK 

public  school  teacher  has  been  assigned  to  the  camp  by  the 
New  York  Board  of  Education. 

It  is  proposed  to  continue  this  work  throughout  the  winter, 
but  no  longer.  The  purpose  of  the  Association  is  to  make  a 
demonstration  which  will  induce  public  authorities  and  private 
organizations  or  individuals  to  establish  permanent  hospitals 
for  this  class  of  cases. 

Application  should  be  made  to  The  New  York  Association 
for  Improving  the  Condition  of  the  Poor,  105  East  226.  Street, 
New  York  Citv. 


100 


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Roche;ster  Hospitai,  for  Incipient  Cases. 


NEW    YORK 


PAUL  SMITHES  (P.  O.  Gabriels). 

Sanatorium  GabrieIvS   (1897)  : 

For  early  cases  of  consumption  and  convalescents  from 

other  pulmonary  diseases. 
Capacity:  70. 
Terms :  From  $10  to  $18  per  week,  according  to  location 

of  rooms ;  one  free  patient  is  taken  in  every  ten. 
Resident  Physician:  R.  L.  Strong,  M.  D. 

The  location  is  a  broad  park  of  undulating  ground,  rising 
gradually  to  Sunrise  Mount  (altitude  2,000  feet),  which  shelters 
the  building  from  the  north  winds,  and  surrounded  b}^  pine  and 
spruce  forests.  The  sanatorium  consists  of  an  administration 
building,  surounded  by  cottages.  A  special  feature  is  the  sys- 
tem for  heating  and  ventilation,  by  which  air  from  outside  is 
continually  being  warmed  and  introduced  into  the  rooms.  The 
entire  volume  of  air  throughout  the  buildings  is  changed  in  the 
course  of  five  minutes.  The  Sisters  of  Mercy  are  in  charge. 
A  small  magazine.  Forest  Leaves,  is  published  quarterly  by  the 
Sanatorium. 

Application  should  be  made  to  the  Mother  Superior. 

ROCHESTER. 

Hospital  for  Incipient  Cases  oe  Tuberculosis    (May, 
1904)  : 
Capacity :  40. 

Charges  are  according  to  the  ability  of  the  patient,  up 
to  $7  per  week ;   most  of  the  cases  pay  a  little. 

This  hospital  is  maintained  by  the  Rochester  Public  Health 
Association,  as  part  of  its  work  against  tuberculosis.  Its  quar- 
ters are  a  building  known  as  the  Municipal  Hospital,  the  use  of 
which  has  been  granted  by  the  city  authorities.  It  is  situated 
in  twenty-six  acres  of  ground,  and  is  well  adapted  to  the  pur- 
pose for  which  it  is  being  used. 

Applications  should  be  addressed  to  G.  W.  Goler,  M.  D., 
Physician  in  Charge. 


102 


NEW   YORK 


SANTA  CLARA,  Franklin  County. 

HiLiv   Crest  and  Uplands,   summer  vacation  houses,  not 

sanatoriums  (June,  1895)  : 
For  working  girls  and  women  who  are  threatened  with 

tuberculosis  or  are  in  the  incipient  stage. 
Capacity :  56 : 
Terms :    full   board,   $7   per   week,    sometimes   paid   by 

friends   of  the  girls;   others   are  allowed   one  month 

free,  after  which  they  pay  whatever  they  can  afford, 

usually  from  $3  to  $5  per  week. 
Resident  Physician :  Caroline  M.  Stengel,  M.  D. 

The  Working  Girls'  Vacation  Society  exists,  as  its  name 
indicates,  for  the  purpose  of  making  suitable  vacations  possible 
for  working  girls  who  are  broken  down  in  health.  The  two 
houses  at  Santa  Clara  are  used  for  those  who  have  tubercular 
tendencies  or  are  already  in  the  first  stages  of  the  disease.  The 
length  of  stay  is  determined  by  the  examining  physician.  In 
the  summer  of  1903  it  averaged  over  five  weeks  for  the  120  girls 
cared  for. 

Santa  Clara  is  located  in  the  Adirondacks,  40  miles  north- 
west of  Saranac,  on  the  New  York  and  Ottawa  Railroad,  at  an 
altitude  of  1,800  feet.  The  vacation  houses  are  open  from  June 
I  to  November  i. 

Application  should  be  made  to  Miss  E.  A.  Buchanan,  361 
West  34th  Street,  New  York  City. 


103 


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NEW   YORK 

SARANAC  LAKE  (P.  O.  Trudeau.) 

Adirondack  Cottage  Sanitarium  (1885)  : 

For  persons   who  cannot  afford  to  pay  more  than  $5 

per  week   and   who  are   in   the   very   early   stages   of 

pulmonary  tuberculosis  or  are  at  least  favorable  types. 
Capacity:  100;  112  in  summer,  by  the  use  of  tents. 
The  uniform  charge  is  $5  per  week;  there  is  a  free  bed 

fund,  the  interest  of  which  is  applied  to  prolonging  the 

stay  of  needy  patients. 
President:  Edward  L.  Trudeau,  M.  D. 
Resident  Physicians :  Lawrason  Brown,  M.  D.,  and  David 

C.  Twitchell,  M.  D. 

From  a  one-room  cottage  heated  by  a  wood  stove  and  lighted 
by  a  kerosene  lamp  Adirondack  Cottage  Sanitarium  has  grown 
to  a  small  village  of  twenty-five  or  more  buildings — the  main 
building,  twenty-one  cottages,  an  infirmary,  a  pavilion,  a  chapel, 
a  library,  and  a  post-office — situated  in  the  Adirondacks,  a  mile 
from  Saranac  Lake,  at  an  altitude  of  1,650  feet. 

In  the  first  years  of  the  existence  of  this  sanatorium  it  was  a 
problem  to  induce  patients  to  go  to  it  and  to  stay.  Now  not 
one  in  twenty  of  the  applicants  can  be  received,  and  the  waiting 
list  of  successful  applicants  is  usually  long.  For  the  benefit  of 
persons  who  are  attracted  to  Saranac  Lake,  either  in  the  hope 
of  gaining  admission  to  the  sanatorium  or  through  confidence  in 
the  climate,  two  unusual  accessories  have  been  developed.  A 
Bureau  of  Information  is  maintained  in  the  village,  for  the  pur- 
pose of  advising  strangers,  and  helping  them  to  find  boarding- 
places,  and  an  Out-Patient  Department  has,  for  over  three  years, 
given  free  medical  advice  to  patients  on  the  waiting  list  and  to 
unsuccessful  applicants  for  admission  who  cannot  afford  to  pay 
for  medical  treatment.  An  attempt  is  made,  through  the  Co- 
operative Employment  Bureau  conducted  by  the  institution,  to 
find  suitable  work  in  healthful  regions  for  patients  when  they 
leave.  A  monthly  magazine.  The  Outdoor  Life,  is  pviblished  at 
the  sanatorium. 

The  uniform  fee  of  five  dollars  per  week  does  not  cover  much 
more  than  half  the  cost  of  maintenance.  The  deficit  is  made  up 
by  gifts  and  subscriptions.  From  the  beginning  the  summer 
residents  have  been  an  important  source  of  contributions. 

Application  should  be  made  to  any  of  the  following  physi- 
cians :  Dr.  Lawrason  Brown,  Saranac  Lake ;  Dr.  James  Alex- 
ander Miller,  New  York  City:  Dr.  Linsly  Williams,  New  York 
City. 

105 


NEW   YORK 

Reception  Cottage  (April,  1901)  : 

For  "tuberculous  patients  who  come  with  the  expectation 
of  admission  to  the  sanitarium,  but  because  of  acute 
or  advanced  ilhiess  are  refused  admission  and  are 
unable  to  receive  suitable  care  at  a  cost  within  their 
means." 

Capacity:  15. 

Terms :  $7  per  week. 

Medical  Director:  Edward  R.  Baldwin,  M.  D. 

This  is  a  house  maintained  chiefly  by  Miss  Mary  R.  Prescott, 
of  New  Bedford,  Massachusetts.  The  fee  charged  is  almost  $5 
less  per  week  than  the  actual  average  cost  of  maintenance.  The 
building  occupied  at  present  is  a  three-story  modern  dwelling, 
rented  from  year  to  year  and  not  well  adapted  for  hospital  pur- 
poses. A  new  building  for  fifteen  patients  has  just  been  com- 
pleted and  will  be  occupied  January  i,  1905.  Admission  is 
not  granted  by  letter ;  patients  must  be  in  Saranac  Lake  village 
at  the  time  of  application,  which  should  be  made  to  Dr.  Edward 
R.  Baldwin. 


Raymond  Cottage  (June,  1902)  : 

For  early  cases  of  pulmonary  tuberculosis  and  moder- 
ately advanced  ones  if  there  are  no  complications. 

Capacity :  14  in  summer ;  10  in  winter. 

Terms :  $10  per  week  and  up. 

There  is  no  physician  in  residence,  but  the  visiting  staff 
consists  of  Drs.  E.  L.  Trudeau,  E.  R.  Baldwin,  Charles 
C.  Trembly  and  Lawrason  Brown ;  Mrs.  Josephine  R. 
Raymond,  who  is  in  charge,  is  a  trained  nurse  with 
ten  years'  experience  in  the  care  of  tuberculosis  cases 

The  location  is  the  southwestern  slope  of  Mt.  Pisgah,  three- 
quarters  of  a  mile  from  the  post  office,  and  100  feet  above  the 
village.  In  the  main  building  there  are  eight  bed-rooms  for 
patients  and  in  a  smaller  building,  four.  Three  tents  are  used- 
There  are  well-protected  porches,  and  a  sun  parlor  24  feet; 
by  10. 

Application  should  be  made  to  Mrs.  Josephine  R.  Raymonds 

107 


NE:w   YORK 


RuMANAPP  Cottage  (July,  1902)  : 

Patients  are  received  in  all  stages  of  pulmonary  tubercu- 
losis. 

Capacity :  14  in  winter,  20  in  summer. 

Terms:  $8  to  $12  per  week;  there  are  extra  charges  for 
meals  served  in  the  patient's  room  and  for  special 
nursing. 

There  is  no  resident  physician ;  Miss  Rumanapp  is  a 
trained  nurse,  and  the  visiting  staff  consists  of  Drs. 
Brown,  Twitchell,  Baldwin,  Trembly  and  Kinghorn. 

The  house  is  a  two-story  cottage  with  porches  on  two  sides, 
situated  in  the  village,  facing  Lake  Flower.  Tents  are  used  in 
the  summer. 

Application  should  be  made  to  Miss  Edith  Rumanapp,  Lock 
Box  596. 

VERBANK,  Dutchess  County. 

All  Saints'  Homk  (1886) : 

For  men   only;   not   exclusively   for   consumptives,  but 

early  cases  are  received. 
There  is  room  for  10  tuberculous  patients,  in  a  pavilion 

reserved  for  them. 
Terms :  $14  per  week  if  the  applicant  is  able  to  pay ; 

otherwise  there  is  no  charge. 
There   is  no   resident  physician,   nor  any  regularly  ap- 
;  pointed  visiting  physician.     The  place  is  in  charge  of 

the  Brothers  of  Nazareth.     It  is  three  miles  from  the 

railroad    station,    among   the   hills,    at    an   altitude    of 

about  1,000  feet. 

Applications  should  be  addressed  to  the  Brothers  of 
Nazareth. 


108 


NORTH    CAROLINA 

NORTH   CAROLINA 
ASHEVILLE. 

The:  Winyah  Sanitarium  (October,  1888)  ; 

For  diseases  of  the  lungs  and  throat;  far  advanced  or 

hopelessly   exhausted    cases    of   consumption    are   not 

admitted. 
Capacity:  80. 
Terms :  $30  per  week. 
Medical  Director :  Karl  von  Ruck,  M.  D. 

In  January,  1900,  the  Winyah  Sanitarium  took  possession  of 
a  new  establishment.  The  site  "is  a  wooded  park  of  20  acres, 
well  sheltered,  and  just  outside  the  limits  of  the  city  of  Ashe- 
ville,  so  far  removed  from  the  center  of  the  town  as  to  be  free 
from  noise  and  dust,  and  yet  of  easy  access  by  a  branch  of  the 
Asheville  electric  street-car  system,  which  passes  directly 
through  the  grounds." 

The  buildings  "consist  of  a  main  structure,  a  large  annex,  and 
two  cottages,  all  connected  by  glass-enclosed  steam-heated 
porches  and  passages."  There  are  piazzas  with  exposure  in  all 
directions,  some  of  them  enclosed  in  glass  with  movable  win- 
dows. In  addition  to  the  indirect  method  of  steam  heating 
extending  to  all  parts,  there  is  also  an  open  fireplace  in  each 
room.  The  lighting  is  by  electricity;  the  water  supply  is  from 
an  artesian  well.  A  laboratory  for  clinical  work  and  for  sci- 
entific research  is  a  feature  of  the  ec[uipment,  also  special  de- 
partments for  laryngology  and  for  physical  and  electro-thera- 
peutics. 

Applications  should  be  addressed  to  Dr.  Karl  von  Ruck.     . 

St,  Josi;rn  Sanitarium  (1902)  : 
For  all  forms  of  tuberculosis. 
Capacity:  25. 

Terms  :  $15  per  week  and  upwards. 

There  is  no  house  physician ;  any  physician  of  the  city  is 
at  liberty  to  send  patients  to  the  sanitarium. 

At  present  there  is  one  building,  with  a  wide  veranda,  sur- 
rounded by  a  shaded  lawn.  A  new  equipment,  more  complete 
and  extensive,  is  planned.  The  sanitarium  is  in  charge  of  the 
Sisters  of  Mercy,  to  whom  application  for  admission  should  be 
made. 

109 


NORTH    CAROLINA 

Dr.  Ste;ve;ns'  Home;  (May,  1903)  : 

For    non-surgical    cases    of    tuberculosis    in    the    early 

stages. 
Capacity :  8 ;  others  can  be  accommodated  in  a  boarding 

house  near  or  in  tents  during  the  summer. 
Terms :  $20  to  $25  per  week. 
Physician  in  charge :  Martin  L.  Stevens,  M.  D. 

Dr.  Stevens'  Home  is  within  the  town  limits,  but  away  from 
the  busy  and  dusty  streets,  and  is  surrounded  by  a  large,  shady 
lawn. 

For  further  information  application  should  be  made  to  Dr. 
Stevens. 


Ill 


Franklin  Humanitarian  Home. 


PiNESHiRE  Sanitarium. 


NORTH    CAROLINA 

BLACK  MOUNTAIN. 

Franklin  Humanitarian  Home;  (June,  1902)  : 

For  "working-  people  whose  lives  are  worth  saving,"  in 

early  stages  of  pulmonary  tuberculosis. 
Capacity:  12. 
Terms :  $3  per  week. 
There  is  no  resident  physician. 

Here  is  an  attempt  to  provide  for  a  few  of  the  many  persons 
who  go  to  Asheville  for  the  sake  of  the  climate,  but  have  little 
or  no  money  with  which  to  meet  the  expenses  of  board  and  treat- 
ment after  they  arrive.  The  price  charged  for  board  does  not 
cover  expense  of  maintenance,  and  the  deficit  is  made  up  through 
the  efforts  of  Mrs.  M.  Franklin  Mallory,  the  founder  and  man- 
ager of  the  Home.  Each  patient  is  required  to  do  some  regular 
daily  work,  unless  his  physician  advises  against  it. 

The  "Home"  is  situated  on  the  western  slope  of  the  Blue 
Ridge,  twelve  miles  east  of  Asheville,  at  an  altitude  of  about 
2,400  feet.  At  present  it  consists  of  a  twenty-room,  two-story 
house,  on  a  farm  of  200  acres.  Shack  tents  are  being  erected  in 
the  pine  groves  on  the  grounds,  and  by  means  of  these  the 
accommodations  can  be  increased  almost  indefinitely. 

Applications  should  be  sent  to  Mrs.  M.  Franklin  Mallory, 

SOUTHERN  PINES. 

Pineshire  Sanitarium  for  Diseases  oe  the  Lungs  and 
Throat  (November,  1901)  : 
Patients  are  received  in  the  first  and  second  stages  of 

pulmonary  tuberculosis. 
Capacity :  30. 

Terms:  $17.50  to  $35  per  week. 
Resident  Medical  Director:  Louis  Fielding  High,  M.  D. 

Southern  Pines  is  about  100  miles  from  the  coast,  in  the 
sandy,  turpentine  pine  belt  which  extends  south  to  Florida,  and 
has  an  altitude  of  700  feet.  The  sanitarium  is  a  large  building 
on  a  western  slope,  in  the  suburbs.  Most  of  the  bedrooms  are 
heated  by  open  fire-places  and  all  have  large  windows,  some  as 
many  as  six.  A  wide  veranda  extends  around  the  building,  with 
;i  sun-parlor  on  the  first  floor.  In  this  climate  life  in  the  open 
air  is  attractive  at  all  seasons.  Modern  facilities  for  scientific 
hydrotherapy  have  recently  been  added. 

Application  should  be  made  to  Dr.  Louis  F.  High. 

113 


Branch  Hospital  for  Consumptives. 


OHIO 

OHIO 

State  vSanatorium  : 

Thirty-five  thousand  dollars  was  appropriated  by  the  legis- 
lature in  1904,  to  begin  work  on  a  state  sanatorium.  It  is  hoped 
that  this  initial  sum  will  suffice  for  the  purchase  of  land  and  for 
the  preparation  of  architect's  plans,  and  that  an  appropriation 
for  construction  and  equipment  will  be  made  during  the  legisla- 
tive session,  1904-1905.     (See  pages  246,  247.) 

CINCINNATI. 

The:  Branch  Hospital  for  Consumptives  (July,  1897)  : 
For  persons  in  any  stage  of  pulmonary  tuberculosis  who 

have  been  residents  of  the  city  for  at  least  one  year. 
Capacity:  120  in  winter;  in  summer  it  can  be  extended 

indefinitely  by  the  use  of  tents. 
There  are  no  charges  to  residents  of  the  city ;  for  patients 

coming  from  outside,  or  for  those  who  wish  private 

rooms,  the  rate  is  $14  per  week. 
There  is  no  physician  in  residence ;  the  visiting  physician 

is  B.  F.  Tyle,  M.  D. 

This  is  a  city  institution,  but  it  is  situated  outside  of  the  city 
in  its  own  grounds  of  52  acres.  The  altitude  is  850  feet.  The 
main  buildings  consist  of  nine  wards ;  the  solarium  has  one 
large  ward  and  five  private  rooms ;  tents  are  used,  also,  in  what- 
ever number  is  required. 

Applications  should  be  addressed  to  the  Cincinnati  Hospital. 

CLEVELAND. 

Tuberculosis  Sanatorium  oe  the  City  Hospital  (Octo- 
ber, 1903)  : 
For  poor  consumptives  in  any  stage  of  the  disease. 
Capacity :  75. 
There  are  no  charges. 
Resident  Physician  :  J.  C.  Placak,  M.  D. 

The  Sanatorium  is  one  building  two  stories  high  and  200  feet 
in  length,  situated  600  feet  from  any  other  building,  on  the  brow 
of  a  hill  overlooking  the  city.  There  are  four  wards  and  sixteen 
private  rooms,  and  twelve-foot  porches  on  three  sides  of  the 
building. 

Application  should  be  made  to  Fred.  C.  Emde,  Superin- 
tendent. 

115 


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OHIO 


DAYTON. 

The  Miami  Vaij.ky  Hospital  has,  for  two  years,  reserved 
for  consumptives  a  small  isolation  building,  with  accommoda- 
tions for  three  patients.  These  beds  are  free.  One  tent  also 
is  used.    There  are  two  resident  physicians  in  the  Hospital. 

Applications  should  be  made  to  the  Superintendent. 

PRICE  HILL,  Cincinnati. 

Western  Hill  Hospital  and  Sanitarium  (1894)  : 
Exclusively  for  early  cases  of  tuberculosis. 
Capacity :  30. 
Terms :    ten    patients    are    treated    free   of    charge ;    for 

others,  $10,  $15  or  $25  per  week. 
Resident  Physician :  Oswald  Katz,  M.  D. 

The  Hospital  is  located  on  an  eighty-acre  plot  900  feet  above 
sea  level,  near  the  Ohio  River.  There  are  twelve  specially  con- 
structed cottages  arranged  in  a  semi-circle  on  the  crest  of  a  hill 
and  separated  from  one  another  by  a  ten-foot  space ;  also  other 
cottages  for  diet  kitchen  and  nurses.  All  the  buildings  have 
adjustable  glass  roofs  and  verandas  extending  entirely  around. 

Application  should  be  made  to  Dr.  Oswald  Katz. 


117 


PENNSYLVANIA 


PENNSYLVANIA 
State;  Sanatorium  : 

Attempts  to  secure  the  establishment  of  a  state  sanatorium 
have  been  made  at  various  times  by  the  Pennsylvania  Society 
for  the  Prevention  of  Tuberculosis,  but  they  have  not  been  suc- 
cessful. The  state  contributes,  however,  to  the  support  of  cer- 
tain private  institutions. 

GREENTOWN,  Pike  County. 

Privatk  Tent  Camp  (June,  1904)  : 

Exclusively  for  early  cases  of  pulmonary  tuberculosis.. 
Capacity :  4  in  winter ;    7  in  summer. 
Terms  :  $80  per  month. 

Resident  Physician :  Albert  S.  Ashmead,  M.  D. 
The  Camp  is  situated  in  the  Pocono  Mountains  at  an  altitude 
of  2,000  feet.  Each  patient  has  his  own  tent  or  wooden  chalet, 
facing  east,  as  the  storms  are  generally  from  the  northwest. 
Greentown  is  reached  by  stage  from  Gouldsboro,  the  nearest 
railroad  station,  which  is  on  the  Delaware,  Lackawanna  and 
Western  Railroad. 

Application  should  be  made  by  the  patient's  physician  to 
Dr.  Albert  S.  Ashmead. 

LANSFORD  (P.  O.  Summit  Hill). 

Mt.  Jefferson  Sanatorium  (1904)  : 

For  all  stages  of  pulmonary  and  laryngeal  tuberculosis. 

Capacity :  25. 

Terms  :  $10  per  week. 

Resident  Physician :  W.  H.  Clewell,  M.  D. 

During  the  first  summer  of  its  existence  this  sanatorium  has 
consisted  of  a  tent  camp  on  the  top  of  Sharp  Mountain,  1,600 
feet  above  sea  level.  It  is  the  intention  to  erect  dormitories  and 
administration  buildings  for  winter  use.  The  institution  is  de- 
signed to  meet  the  needs  of  that  large  class  of  consumptives 
who  are  able  to  pay  a  moderate  fee  for  treatment,  but  not  the 
ordinary  sanatorium  prices. 

Application  should  be  made  to  Dr.  W.  H.  Clewell. 


118 


PENNSYLVANIA 


MONT  ALTO,  Franklin  County. 

South  AIountain  Camp  Sanatorium   (March,  1903)  : 

For  consumptives  in  the  early  stages  of  the  disease  who 
are  citizens  of  Pennsylvania  and  not  able,  financially, 
to  go  elsewhere. 

There  are  accommodations  for  38  persons. 

Terms :  shelter  and  fuel  are  free  of  charge,  but  every- 
thing else  must  be  provided  by  the  campers. 

There  is  a  resident  physician,  and  the  consulting  physi- 
cians are  easily  accessible. 

This  is,  as  its  name  indicates,  merely  a  camp  in  the  woods. 
Its  existence  is  due  to  the  interest  and  initiative  of  Dr.  Rothrock, 
the  State  Commissioner  of  Forestry.  The  land  and  buildings 
are  state  property.  All  that  the  state  furnishes,  however,  is 
''shelter,  fuel,  air,  and  water."  Campers  are  expected  to  make 
their  own  arrangements  about  food  and  other  provisions.  There 
are  eleven  plain  board  cabins,  ten  feet  square,  intended  for  two 
men  each,  and  seven  cottages  for  women,  each  with  two  rooms 
and  a  small  kitchen.  Cots  and  stoves  are  the  only  furniture  pro- 
vided. A  large  assembly  building  has  been  erected  for  the  use 
of  all. 

From  the  beginning  the  number  of  applications  has  far  ex- 
ceeded the  accommodations,  in  spite  of  the  slight  attractions 
offered  and  the  strict  enforcement  of  certain  rules  in  the  camp. 

Applications  should  be  addressed  to  Dr.  J.  T.  Rothrock. 

Private  Sanatorium   (to  be  opened  June,  1905)  : 

A  private  sanatorium,  intended  to  be  a  comfortable  home 
for  about  ten  patients,  will  be  opened,  in  the  summer  of  1005, 
within  half  a  mile  of  the  South  Mountain  Camp  Sanatorium, 
by  Drs.  J.  T.  and  A.  M.  Rothrock. 

Inquiries  should  be  addressed  to  Dr.  J.  T.  Rothrock,  Mont 
Alto,  Franklin  County. 


119 


The  Sheppard  Cottage,  Hospital  for  Diseases  of  the  Lungs. 


WiLSTACH    COT'J'AGE,    HOSPITAL    FOR    DISEASES    OF   THE    LUNGS. 


PKNNSYL,VANIA 

PHILADELPHIA. 

PhiIvAdelphia  General  HospitaIv,  34th  and  Pine  Streets : 

For  the  poor  of  the  city ;    consumptives  are  segregated. 

Capacity  of  the  tuberculosis  buildings:  174. 

All  beds  are  free. 

Chief  resident  physician :  M.  H.  Biggs,  M.  D. 

For  ten  years  the  consumptives  have  been  isolated  in  wards. 
New  buildings  have  just  been  constructed,  especially  designed 
for  the  treatment  of  tuberculosis.  They  include  a  hospital  of  66 
beds  and  six  pavilions  made  entirely  of  glass  and  steel,  each 
accommodating  18.  These  buildings  are  on  the  highest  part 
of  the  hospital  grounds,  not  far  from  the  river.  During  the 
summer  of  1903  the  hospital  roof  was  converted  into  a  ward 
where  as  many  as  possible  of  the  patients  in  the  earlier  stages 
of  consumption  were  kept  night  and  day. 

Application  should  be  made  to  the  Chief  Resident  Physician. 

The  Henry  Phipps  Institute  maintains  a  hospital  for  ad- 
vanced  cases   of   tuberculosis,   at   238   Pine    Street. 
(See  page  248.) 

Hospital  for  Diseases  oe  the  Lungs,  Chestnut  Hill 
(1876): 

For  women  unable  to  pay  for  proper  treatment ;  all  stages 
of  pulmonary  tuberculosis  are  received,  and  cases  of 
bronchitis,  but  most  of  the  patients  are  consumptives  in 
an  advanced  stage. 

Capacity:  60;   there  is  room  in  tents  for  14  more. 

There  are  no  fixed  charges,  but  patients  and  their  friends 
are  expected  to  contribute,  according  to  their  means, 
toward  the  support  of  the  hospital. 

Consulting  Physician :   J.  Solis  Cohen,  M.  D. 

Resident  Physician :  Anna  L.  Bacon,  M.  D. 

Visiting  Physicians :  Drs.  Wm.  M.  Angney,  Charles  A. 
Currie,  J.  Clinton  Foltz,  Myer  Solis  Cohen ;  Arthur 
W.  Watson,  laryngologist ;  Robert  L.  Pitfield,  bacteri- 
ologist. 

This  Hospital,  and  the  House  of  Mercy  (see  page  122)  were 
established  by  the  Philadelphia  Protestant  Episcopal  City  Mis- 

121 


PENNSYLVANIA 

sion  in  1876,  and  were  the  first  institutions  in  Pennsylvania 
especially  for  consumptives.  More  than  3,500  patients  have 
been  cared  for  by  this  organization,  either  at  home  or  in  the 
hospital.  No  distinction  is  made  on  account  of  nationality, 
creed,  or  color. 

At  Chestnut  Hill  buildings  designed  especially  as  a  hospital 
for  consumptives  have  been  erected.  They  are  located  on  an 
elevated  piece  of  ground,  500  feet  above  tide  water,  one  of  the 
highest  points  near  Philadelphia.  There  are  four  hospital  build- 
ings and  one  administration  building.  The  institution  is  con- 
ducted on  the  separate  principle,  each  patient  having  her  own 
room.  All  bedrooms  face  due  south.  Two  of  the  hospital 
buildings  have  been  furnished  with  wide  open  porches,  on  which 
the  beds  of  the  patients  are  placed.  In  stormy  weather  heavy 
awnings  are  dropped  to  the  floor.  The  fresh-air  treatment  has 
been  in  force  for  nearly  ten  years.  In  the  summer  of  1903  tent 
life  was  introduced;  this  was  tried  again  in  1904,  and  in  both 
years  was  continued  until  high  winter  winds  rendered  the  tents 
insecure. 

Application  should  be  made  to  Rev.  H.  L.  Duhring,  D.  D., 
Old  St.  Paul's  Church,  226  South  Third  Street,  Philadelphia. 

The  House;  of  Me:rcy,  411  Spruce  Street  (1876)  : 

For  consumptive  men,  in  all  stages  of  the  disease,  who  are 

unable  to  procure  suitable  care  elsewhere. 
Capacity:   12. 
There  are  no  charges ;    patients  are  requested  to  make 

some  contribution  if  they  are  able  to  do  so. 
House  Physician :  William  Muir  Angney,  M.  D. 

Almost  all  of  the  patients  here  are  advanced  cases.  They 
are  cared  for  in  four  small  wards  in  a  city  house.  A  roof  gar- 
den is  used  for  open-air  treatment.  This  institution  is  main- 
tained by  the  Protestant  Episcopal  City  Mission.    ( See  page  121 ) . 

Application  should  be  made  to  Rev.  H.  L.  Duhring,  D.  D., 
Old  St.  Paul's  Church.  225  South  Third  Street. 


122 


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PENNSYLVANIA 


Rush  Hospital,  Lancaster  Avenue  and  Thirty-third  Street 
(1892): 

Exclusively  for  treatment  of  pulmonary  and  laryngeal  tu- 
berculosis; patients  in  all  stages  are  received. 

Capacity:  City  Hospital,  40;  Country  Branch,  25. 

Terms :  $5  per  week  in  the  wards ;  $10  to  $20  in  private 
rooms. 

There  is  no  resident  physician,  but  the  visiting  physicians, 
S.  Solis  Cohen,  M.  D.,  and  T.  Mellor  Tyson,  M.  D., 
are  always  accessible. 

The  City  Hospital  consists  of  two  wards,  an  open-air 
pavilion,  and  private  rooms. 

The  Country  Branch,  at  Malvern,  Pennsylvania,  accom- 
modates 25  patients  in  small  rooms,  open-air  shelters, 
and  tents. 

A  larger  city  hospital,  with  provision  for  at  least  80  patients, 
is  now  building.  The  institution  is  supported  by  a  state  en- 
dowment, fees  from  patients,  and  voluntary  contributions. 

Application  should  be  made  to  the  Superintendent. 

LuciEN  Moss  Home;,  Jewish  Hospital,  York  Pike  and  Tabor 
Road   (June,  1900)  : 
For  poor  consumptives  of  Jewish  faith,  in  any  stage  of 

the  disease. 
Capacity  :  3 1 . 
There  are  no  charges. 
Chief  Resident  Physician :  Edwin  D.  Jarecki,  M.  D. 

The  building  is  of  brick,  four  stories  high,  with  sun  parlors 
and  separate  rooms  for  patients.  All  the  sleeping  rooms  have  a 
southern  exposure. 

Application  should  be  made  to  Dr.  Edwin  A.  Jarecki. 


124 


rENNSYI^VANIA 


The;  Dermady  Sanatorium,  Gowen  Avenue  and  Sprague 
Street,  Mt.  Airy  (June  i,  1904)  : 
Exclusively  for  pulmonary  tuberculosis. 
Capacity :  25. 

Terms:  $12  to  $27.50  per  week. 

There  is  no  resident  physician ;  patients  can  have  the 
advice  of  Drs.  Lawrence  F.  Flick,  William  B.  Stanton, 
Joseph  Walsh,  D.  J.  McCarthy,  H.  M.  B.  Landis,  and 
Charles  Hatfield. 

This  sanatorium  is  twelve  miles  from  Philadelphia,  at  an 
altitude  of  500  feet.  The  main  building  is  a  three-story  house 
of  gray  stone,  and  the  annex,  which  will  accommodate  twelve 
patients,  is  a  smaller  building,  of  stone  and  wood.  Over  two 
acres  of  wooded  lawn  surround  the  houses.  Graduate  nurses 
and  a  graduate  in  hydrotherapy  are  in  attendance.  Any  phy- 
sician may  place  and  treat  patients  in  this  institution. 

Application  for  admission  should  be  made  to  Miss  Margaret 
G.  O'Hara. 

PITTSBURG. 

The  Tuberculosis  Hospital  (projected)  : 

For  poor  consumptives  of  Pittsburg  and  Allegheny,  in 

any  stage  of  the  disease.    ■ 
Capacity :  at  least  50. 
There  will  be  no  charges. 

An  association  has  been  formed  by  prominent  citizens  of 
Pittsburg  for  organized  and  systematic  work  among  the  con- 
sumptive poor  of  the  city.  The  first  efforts  will  be  directed 
toward  establishing  a  free  hospital.  Four  acres  of  land  on  a 
hill  in  the  city,  with  buildings  easily  adaptable  to  the  require- 
ments of  a  hospital,  have  been  given  for  the  purpose.  The 
altitude  is  about  1,200  feet,  and  the  buildings  command  a  view 
of  the  Allegheny  and  Ohio  River  valleys. 

For  the  present  inquiries  should  be  addressed  to  Dr.  Henry 
Martyn  Hall,  Jr.,  253  Shady  Avenue,  Pittsburg. 


126 


The  Dermady  Sanatorium. 


PENNSYIvVANIA 


SCRANTON. 

West  Mountain  Sanatorium  (August,  1903)  : 

For  poor  consumptives  resident  in  Scranton ;    all  stages 

are  received. 
Capacity :  24. 
Terms:  there  is  a  maximum  charge  of  $5  per  week  for 

those  who  are  able  to  pay ;  others  are  admitted  free. 
There  is  no  physician  in  residence,  but  an  attending  staflf 

of  six. 

This  institution  is  located  on  a  sixty-acre  farm,  just  outside 
the  city  limits,  on  a  mountain  side,  at  an  elevation  of  1,600  feet. 
It  is  expected  that  when  the  land  is  fully  developed  it  will  fur- 
nish all  the  milk,  eggs,  and  garden  produce  needed.  Patients 
able  to  work  are  required  to  do  so. 

The  hospital  building  has  two  wards  of  ten  beds  each,  and  is 
heated  by  steam.  There  are  also  four  shacks  for  two  patients 
each,  which  can  be  used  all  winter ;  nine  others  for  summer ;  a 
farmhouse,  a  barn  and  a  laundry. 

The  funds  for  construction  and  maintenance  are  derived 
wholly  from  voluntary  contributions,  the  fees  from  patients  be- 
ing practically  a  negligible  amount.  The  sanatorium  was  estab- 
lished and  is  maintained  by  the  Scranton  Society  for  the  Preven- 
tion and  Cure  of  Consumption  (see  page  250). 

Applications  should  be  addressed  to  Dr.  J.  M.  Wainwright, 
d^"]  Linden  Street. 


128 


PENNSYLVANIA 

WHITE  HAVEN. 

Free  H/jspital  for  Poor  Consumptives  (1901)  : 

For  residents  of  Pennsylvania  in  the  early  stages  of  tu- 
berculosis who  are  not  financially  able  to  provide  pro- 
per treatment  for  themselves. 

Capacity :   100. 

There  are  no  charges. 

Superintendent :  James  H.  Heller,  M.  D. 

President  of  the  Board  of  ^Managers :  Lawrence  F.  Flick, 
M.  D. ;    there  are  two  resident  physicians. 

The  grounds  include  215  acres  in  the  Blue  Mountains,  at  an 
altitude  of  about  1,500  feet. 

The  Hospital  was  founded  in  1895,  but  for  the  first  six 
years  its  beneficiaries  were  boarded  in  existing  institutions.  The 
nucleus  of  the  present  equipment  was  a  barn,  which  in  1901  was 
transformed  into  a  pavilion  accommodating  sixty  patients. 
There  have  been  built,  since,  three  cottages,  wath  a  capacity  of 
sixteen  each.  An  administration  building  and  superintendent's 
quarters  are  almost  ready  for  occupancy. 

Funds  for  maintenance  are  provided  by  contributions  from 
the  public  and  a  state  appropriation. 

Application  should  be  made  to  Miss  Helen  C.  McDevitt,  Sec- 
retary, 204  South  Seventh  Street,  Philadelphia. 

SuNNYREST  SANATORIUM  f  November,  1901)  : 
For  early  cases  of  pulmonary  tuberculosis. 
Capacity :  50. 

Terms:  $15  to  $25  per  week. 
The  place  of  resident  physician  is  supplied  by  a  physician 

in  the  village. 
Visiting  staff:  Drs.  Lawrence   F.   Flick,  Joseph  AA^alsh,. 
\Vm.  B.  Stanton,  Henry  ^L  Xeale,  Chas.  J.  Hatfield, 
N.  M.  R.  Landis,  D.  A.  McCarthy,  A.  M.  Shoem.^.ker. 
This  private  sanatorium  is  situated  among  the  mountains, 
overlooking  the  Lehigh  Valley,  1,200  feet  above  sea  level.     The 
soil  is  dry,  porous  shale.     The  main  building  contains  adminis- 
tration of^ces  and  twelve  bedrooms.     There  are  also  three  cot- 
tages and  a  central  dining  hall,  and  from  April  to  November 
tents  are  used. 

Application  should  be  made  to  Elwell  Stockdale,  Superin- 
tendent. 

129 


RHODE   ISLAND 

RHODE   ISLAND 

State;  Sanatorium  for  Consumptives   (to  be  opened  in 
IQOS).  situated  at  Pascoag: 
Exclusively  for  early  cases  of  tuberculosis. 
Capacity :  loo. 
Terms :  not  yet  fixed,  but  all  will  be  expected  to  pay 

something. 
There  will  be  resident  physicians. 
The  buildings,  which  were  completed  in  the  spring  of  1904^ 
consist  of  a  three-story  administration  building,  connected  by 
covered  corridors  with  a  two-story  pavilion  on  each  side.  The 
site,  near  Wallum  Pond  in  the  extreme  northwestern  part  of  the 
state,  has  an  elevation  of  about  600  feet.  It  is  expected  that 
the  state  will  assume  one-half  the  expense  of  support,  the  other 
half  to  be  borne  by  the  patient. 

Application  should  be  made  to  the  Commission  on  a   State 
Sanatorium    for    Consumptives. 

FOSTER. 

Pine  Ridge  Camp  eor  Consumptives  (1903)  : 

Capacity :  25  in  winter,  to  be  increased  this  year ;    60 

from  early  spring  until  late  fall. 
Terms :  each  patient  is  expected  to  pay  what  he  can,  up 

to  a  maximum  of  $7  per  week. 
Superintendent:  William  H.  Peters,  M.  D.,  21  Waterman 

Street,  Providence. 
A  physician  is  in  residence  during  the  summer,  and  there 
is  a  large  consulting  and  visiting  stafif ;    both  men  and 
women  nurses  are  always  in  attendance. 
A  New  England  farm  of  50  acres  is  the  site  of  this  camp. 
It    has    a    southern    exposure,    is    almost    surrounded    by    pine 
forests,  and  has  an  altitude  of  600  feet.     The  soil  is  porous ; 
there  is  spring  water  on  the  place,  and  trout  streams  and  hunt- 
ing near.     The  plant  consists  of  an  administration  building  of 
rough  boards,   ten   cabins    10  by    12   feet,   accommodating  two 
patients  each,  a  separate  kitchen  and  dining-room,  and  twenty- 
two  tents.     Abandoned  trolley  cars  have  also  been  pressed  into 
service,  and  transformed  into  bed-rooms,  one  patient  in  each,. 
as  a  step  toward  solving  the  problem  of  economy. 

Application  should  be  made  to  Dr.  William  H.  Peters,  21 
Waterman  Street,  Providence. 

131 


Shack  at  Pine  Ridge  Camp. 


Abandoned  Trolley  Car  in  Use  at  Pine  Ridge  Camp. 


KHODU   ISLAND 


HOWARD. 

State  Almshouse. 

Tuberculous  patients,  in  whatever  stage  of  advancement, 

are  separated  from  the  others. 
Capacity  of  tuberculosis  buildings :  40. 
There  are  no  charges. 
Physician  in  Charge :  George  F.  Keene,  M.  D. 

For  eight  years  the  tuberculous  patients  in  this  institution 
have  been  cared  for  in  a  separate  building.  There  are  two  long 
wards,  one  for  men  and  one  for  women.  Patients  are  kept  out 
of  doors  as  much  as  possible. 

PROVIDENCE. 

St.  Joseph's  Hospital  : 

Two  wards  are  reserved  for  tuberculosis ;    all  stages  of 

advancement  are  admitted. 
Capacity  of  the  tuberculosis  wards :  24. 
The  hospital  is  primarily  for  the  poor ;    if  a  patient  is 
able  to  do  so  he  pays  a  small  sum,  never  more  than 
$7  per  week. 
Resident  Physician  :  William  Hindle,  M.  D. 

The  hospital  is  a  six-story  brick  building,  situated  on  a 
slight  elevation  in  a  residence  district  of  the  city.  Its  chief 
source  of  support  is  voluntary  contributions. 

Application  should  be  made  to  Sister  M.  Eulalia. 


133 


SOUTH  CAROI.INA 


SOUTH   CAROLINA 

AIKEN. 

The  Aiken  Cottages  (October,  1896)  : 

For  men  in  reduced  circumstances  with  incipient  pul- 
monary tuberculosis. 

Capacity:  15. 

There  are  two  free  beds ;  for  others  the  charge  is  $5  per 
week. 

Medical  Director,  in  residence :  Charles  F.  McGahan, 
M.  D. 

The  Aiken  Cottages  originated  with  a  group  of  Massa- 
chusetts men  and  women  who  were  impressed  with  the  need  of 
some  place  where  yovmg  men  attracted  to  Aiken  by  the  climate, 
but  friendless  and  unable  to  pay  for  proper  care,  might  find  a 
chance  for  health.  Of  the  eight  directors,  four  are  residents 
of  Massachusetts,  so  that  it  is  largely  a  New  England  enter- 
prise. 

Aiken  is  a  small  village  located  on  a  sand  ridge  running 
from  east  to  west  across  the  state.  The  sanatorium  is  at  the 
western  edge  of  the  town,  on  the  highest  point  of  ground,  at  an 
altitude  of  565  feet.  Artesian  wells,  sunk  to  a  depth  of  800 
feet,  supply  the  water.  The  main  building  contains  the  adminis- 
tration offices,  general  rooms  and  bedrooms  for  seven  patients. 
A  smaller  cottage,  accommodating  four,  has  been  added;  and 
recently  two  tents,  for  two  men  each.  Each  patient  has  his 
own  room,  but  sleeps  on  the  piazza  outside.  The  aim  of  the 
founders  and  directors  has  been  from  the  beginning  to  keep 
the  characteristics  of  a  home  rather  than  of  an  institution. 

The  charge  of  five  dollars  per  week  represents  less  than 
half  the  cost  of  maintenance,  the  deficit  being  supplied  by  gifts. 

Application  should  be  made  to  Dr.  Charles  F.  McGahan. 


135 


TEXAS 


TEXAS 

COMFORT,  KendaU  County. 

Camp  Reuanck  (May,  1902)  : 
For  early  cases  of  tuberculosis. 
The  capacity  can  be  indefinitely  increased  by  the  addition 

of  tents. 
There  were  25  residents  in  February,  1904. 
Terms :  $1  per  day ;   $25  per  month. 
Manager  and  owner :  C.  H.  Wilkinson,  M.  D. 

Camp  Reliance  is  pitched  near  the  Guadeloupe  River,  on  the 
summit  of  a  hill,  two  miles  from  the  German  village  of  Kendall. 
There  is  a  flag  station  at  the  Camp  for  the  benefit  of  residents. 
The  elevation  is  1,700  feet.  In  the  main  building,  70  by  40  feet, 
are  the  dining-room,  parlors  and  baths.  The  bed-rooms  are 
tents,  well  ventilated  and  built  on  floors  six  inches  above  the 
ground. 

Application  should  be  made  to  Dr.  C.  H.  Wilkinson. 

EL  PASO. 

Sisters'  Hospital,  Hotel  Dieu  (1894)  : 

A  general  hospital,  but  consumptives  are  cared  for  in  a 

separate  wing. 
Capacity  of  tuberculosis  wing :  50. 
There  is  always  a  resident  physician. 

The  hospital  is  situated  on  a  hill  in  the  residence  portion 
of  the  town.  It  is  a  five-story  brick  structure,  heated  by  steam, 
lighted  by  gas  and  electricity.  The  Sisters  of  Charity  are  in 
charge. 

Application  should  be  made  to  Sister  Regina, 


136 


VERMONT,   VIRGINIA,    WASHINGTON 

VERMONT 

State  Sanatorium  : 

The  State  Tuberculosis  Commission  (see  page  251)  is  re- 
quested to  incorporate  in  its  report  to  the  legislature  recom- 
mendations in  regard  to  sanatorium  provision ;  and  the  State 
Society  for  the  Prevention  of  Tuberculosis  (see  page  252)  will 
use  all  its  influence  to  support  such  recommendations. 

SOUTH  HERO. 

Champlain  Open-Air  Sanitarium  (1903): 

Not  exclusively  for  consumptives,  but  early  cases  are  re- 
ceived and  accommodated  in  separate  cottages. 
Capacity :  30. 

Terms:  $15  to  $35  per  week. 

Resident   Physicians :   H.   E.   Lewis,   M.   D.,   and   F.   C. 
Lewis,  M.  D. 
This  institution   is   open   only   during  the  summer  months, 
from  May  i  to  November  i.     It  is  on  the  cottage  plan. 

Application  should  be  made  to  Dr.  H.  E.  Lewis,  Burlington. 

VIRGINIA 

State  Sanatorium  : 

A  bill  for  the  establishment  of  a  state  sanatorium  has  re- 
ceived consideration  in  the  legislature,  but  failed  of  passage. 

SEATTLE.  WASHINGTON 

King    County    Hospitae,    tent    colony    for    consumptives 
(started  in  July,  1903)  : 
For  const\mptives  without  resources   who  have  been   in 

King  County  at  least  six  months. 
Capacity  of  tent  hospital :   15. 
All  beds  are  free. 

Superintendent  :William  P.  O'Rourke,  M.  D. 
The  tents  are  located  on  the  grounds  of  the  County  Hospital, 
four  miles  from  Seattle,  in  the  Valley  of  the  Duwamish  River. 
They  are  so  constructed  that  the  canvas  forming  both  the  roof 
and  the  side  walls  can  be  raised  and  lowered,  as  sun  or  wind 
dictate.  All  the  tents  are  supplied  with  hot  and  cold  water. 
Patients  are  given  five  meals  daily,  and  all  their  eating  utensils 
are  kept  separate. 

Application  should  be  made  to  the  Board  of  County  Com- 
missioners, j^g- 


WISCONSIN 


WISCONSIN 

Stats  Sanatorium  : 

The  State  Tuberculosis  Commission  (see  page  252)  will 
recommend  to  the  legislature  the  establishment  of  a  state  sana- 
torium for  early  cases. 

LAKE  NEBAGAMON. 

Evergreen  Park  Cottage  Sanatorium  (Ma)^,  1903)  : 

For  early  cases  of  pulmonary  tuberculosis,  and  for 
children  with  tubercular  glands  or  joints. 

Capacity:  12,  in  cottages. 

Terms :  $15  per  week  in  cottages ;  persons  unable  to  meet 
this  expense  are  allowed  to  build  their  own  shacks  or 
pitch  tents  on  the  grounds,  provided  they  comply  with 
the  same  regulations  as  the  regular  patients,  and  are 
given  medical  attendance  at  the  rate  of  $10  per  month. 

Medical  Director:  W.  B.  Hopkins,  M.  D. 

The  sanatorium  is  open  from  May  i  to  November  i.  It  is 
thirty  miles  from  Lake  Superior,  on  the  Duluth,  South  Shore 
and  Atlantic  Railroad,  in  the  extreme  northwest  of  the  state, 
and  the  altitude  is  1,106  feet.  The  cottages  are  situated  on  a 
gentle  slope  of  sandy  soil  facing  southwest.  They  are  so 
constructed  that  the  occupants  practically  sleep  out  of  doors, 
and  all  are  required  to  be  in  the  sunshine  all  day.  The  life  is 
simple  and  informal,  but  implicit  obedience  to  the  general 
sanitary  regulations  and  to  the  individual  advice  of  physician 
and  nurses  is  insisted  upon. 

Application  should  be  made  to  Dr.  W.  B.  Hopkins,  Cumber- 
land. 


138 


WISCONSIN,  CANADA 


TOMAHAWK,  Lincoln  County. 

The  Wisconsin  Health  Park  Association  was  organ- 
ized in  ]\Iarch,  1902,  "to  establish  and  maintain  a  Health  Park 
or  Parks  in  northern  Wisconsin  where  invalids  (especially 
incipient  cases  of  tuberculosis)  may  be  sent  for  improvement 
and  recovery." 

A  tract  of  240  acres,  chiefly  pine-covered  hills,  at  Tomahawk, 
in  Lincoln  County,  has  been  donated,  and  the  work  of  clearing 
parts  of  it  for  cultivation  and  for  the  erection  of  cottages  has 
been  begun.  The  plan  is  to  provide  for  all  who  wish  to  go  to 
it,  giving  to  those  with  limited  means  an  opportunity  to  pay  for 
their  maintenance  by  working  a  few  hours  a  day.  It  is  expected 
that  a  few  patients  can  be  received  in  the  spring  of  1905. 

The  funds  for  the  work  of  the  Association  are  derived  en- 
tirely from  voluntary  contributions.  Over  three  hundred  and 
fifty  men  and  women  of  Wisconsin  are  enrolled  as  members. 
This  is  a  charitable  enterprise ;  none  of  the  officers  receives  any 
pay  and  all  the  gifts  are  used  to  improve  the  land. 

Inquiries  should  be  addressed  to  Dr.  W.  P.  Roberts,  Field 
Secretary,  Janesville. 

CANADA 
BRITISH  COLUMBIA. 

A  Provincial  Sanatorium  is  projected.  It  is  hoped  that 
work  may  be  begun  during  the  course  of  the  year. 

MANITOBA. 

A  Provincial  Sanatorium,  to  be  built  in  the  vicinity  of 
Winnipeg,  is  projected,  but  no  action  has  yet  been  taken  by  the 
legislature. 


139 


CANADA 


NOVA  SCOTIA. 

ProvinciaIv   Sanatorium    (now  building)  : 
For  early  cases  of  pulmonary  tuberculosis. 
Capacity:  i8. 

A  site  has  been  secured  at  Kentville,  on  a  bluff  250  feet  above 
sea  level,  and  open  to  the  south  and  southwest.  The  first  build- 
ing will  be  two  stories  high  and  will  contain  18  rooms  for 
patients,  general  rooms,  sun-parlors,  apartments  for  officers 
and  staff.  It  is  hoped  that  it  will  be  ready  for  occupancy  this 
summer. 

The  sanatorium  will  be  supported  by  the  provincial  and 
municipal  governments. 

Inquiries  should  be  addressed  to  Dr.  George  L.  Sinclair,  25 
Tobin  Street,  Halifax. 

Woh^vih'LZ  Highlands  Sanatorium  (May,  1902)  : 
Exclusively  for  early  cases  of  tuberculosis. 
Capacity :  8. 
Terms :  $8  per  week ;  but  when  an  applicant  is  not  able 

to   pay   he   is    received    free   of   charge   if   there   is   a 

vacancy. 
Medical  Director :  G.  E.  De  Witt,  M.  D. 

The  sanatorium  consists  of  two  cottages,  connected  bv  a 
solarium,  and  supplied  on  the  west,  north  and  south  with 
verandas,  some  of  which  are  enclosed.  It  is  on  the  Wolfville 
Ridge,  a  spur  of  the  South  Mountain,  and  has  an  altitude  of 
300  feet. 

Application  should  be  made  to  Dr.  G.  E.  De  Witt. 


140 


CANADA 


ONTARIO. 

MusKOKA  Cottage  Sanatorium,  Gravenhurst   (1897)  : 
Primarily    for    early    cases    of    pulmonary    tuberculosis, 

but  those  moderately  advanced  are  admitted   if  they 

have  a  fair  chance  for  recovery. 
Capacity :  75  in  winter,  85  in  summer. 
Terms  :  $12  and  $15  per  week. 
Physician  in  charge:  J.  H.  Elliott,  M.  B. 

The  sanatorium  was  established  through  gifts  from  indi- 
viduals and  from  the  town  of  Gravenhurst.  Funds  for  mainte- 
nance are  supplied  by  the  fees  from  patients  and  a  small  grant 
of  $2,000  from  the  provincial  government. 

It  is  situated  in  a  wooded  park  of  50  acres,  sheltered  on  the 
north  and  northwest  by  rocky  ridges  and  pine  forests.  Toward 
the  south  and  southwest  it  overlooks  the  southern  arm  of  Lake 
Muskoka.  The  district  is  rocky ;  the  soil  porous  and  dry.  The 
mean  relative  humidity  is  70  to  75  and  the  mean  annual  tempera- 
ture is  42  degrees. 

There  is  a  central  building  which  contains,  besides  the  offices, 
reception  and  dining-rooms,  and  three  solaria,  accommodations 
for  27  patients ;  the  other  buildings  are  five  cottages,  with  an 
aggregate  of  28  beds,  and  ten  roofed  tents  for  two  patients  each. 
The  buildings  face  southwest,  are  lighted  by  electricity  and 
heated  by  steam  and  hot  water.  The  interior  finish  is  hard 
wood,  with  rounded  corners.  The  walls  are  either  cement 
plaster  or  are  painted. 

Both  Muskoka  Cottage  Sanatorium  and  the  Free  Hospital 
at  Gravenhurst  were  established  by  and  are  under  the  direction 
of  the  National  Sanitarium  Association. 

Application  should  be  made  to  the  Physician  in  charge  or 
to  J.  S.  Robertson.  Secretary,  National  Sanitarium  Association, 
IMail  Building,  Toronto. 


141 


MusKOKA  Cottage  Sanatorium. 


Cottage  Tent,  Muskoka  Cottage  Sanatorium. 


CANADA 


MusKOKA  Free  Hospital  for  Consumptives,  Gravenhurst 
(April,  1902)  : 
.  For  persons  in  the  early  stages  of  consumption  who  are 
unable  to  pay  for  sanatorium  treatment. 
Capacity :  75. 

Treatment  is  entirely  free  to  those  who  cannot  afford  to 
pay ;  any  contribution  that  a  patient  is  able  to  make 
is  accepted,  but  this  is  rarely  more  than  three  or  four 
dollars  a  week. 
Physician  in  charge :  Charles  Daniel  Parfitt,  M.  D. 

This,  the  second  institution  established  by  the  National 
Sanitarium  Association,  has  the  same  advantages  of  climate 
and  general  situation  as  the  Muskoka  Cottage  Sanatorium.  Its 
most  important  source  of  income  is  voluntary  contributions ; 
it  is  subsidized  by  the  provincial  government  to  the  amount  of 
&1.50  per  week  for  each  patient;  subscriptions  are  made  by 
patients  and  municipalities ;  and  there  is  a  small  endowment. 

The  administration  building  has  room  for  47  patients ;  there 
are  four  roofed  tents  for  four  patients  each ;  and  a  pavilion  for 
twelve.  The  lighting  is  by  electricity,  the  heating  by  steam 
and  hot  water. 

Patients  who  are  considered  physically  able  have  been  given 
light  work  to  do,  either  in  the  house  or  out  of  doors.  It  has 
been  the  aim  to  give  work  to  graduate  patients,  who,  being 
unable  to  remain  longer  as  patients,  are  thus  enabled  to  prolong 
their  life  under  sanatorium  conditions,  and  at  the  same  time 
become  self-supporting.  A  small  poultry-breeding  plant  has 
been  started,  and  it  is  proposed  to  keep  pigs  and  start  a  vegetable 
garden  as  soon  as  funds  are  available. 

Application  should  be  made  to  J.  S.  Robertson,  Secretary, 
National    Sanitarium    Association,    Mail    Building,    Toronto. 


143 


"^ 


Main  Building,  Muskoka  Free  Hospital. 


The  Veranda,  Muskoka  Free  Hospital. 


CANADA 

Toronto   Frke   Hospital   for   Consumptive   Poor,   four 
miles  from  Toronto,  on  the  Weston  Trolley  Road 
(September,  1904)  : 
Especially    for    advanced    cases,    but   patients    in    earlier 

stages  will  not  be  refused. 
Capacity :  50  at  present ;  to  be  increased  to  100. 
There  is  no  charge  for  patients  who  cannot  afford  to  pay. 
Resident  Physician :  Dr.  Allan  Adams,  B.  A. 
Forty  acres  of  wooded   land  on  the  bank  of.  the  Humber 
River  are  the  site  of  this  new  hospital.     The  management  is  in 
the  hands  of  a  Trust  Board,  of  which  the  chairman  is  Mr.  W. 
j.  Gage,  to  whom  the  National  Sanitarium  Association,  with  its 
two    Muskoka    institutions,    largely    owes    its    existence    and 
growth.      The    buildings    include    an    administration    building, 
pavilions,   and   roofed   tents.      It  will  be   supported  mainly  by 
voluntary  contributions. 

Application  should  be  made  to  J.  S.  Robertson,  Secretary  to 
Trust,  Mail  Building,  Toronto. 

QUEBEC 

A  Provincial  Sanatorium,  for  early  cases  only,  is  pro- 
jected. 

A  grant  of  500  acres  of  land,  in  Trembling  Mountain  Park, 
has  been  made  by  the  Government  to  the  Montreal  League,  for 
the  erection  of  the  necessary  buildings. 

The  Park  of  which  this  land  is  a  part  is  a  natural  preserve 
of  100,000  acres,  enclosing  many  lakes  and  mountains.  The 
site  of  the  projected  sanatorium  is  at  the  entrance  to  the  Park. 

LahIv  Ghur,  Ste.  Agathe  des  Monts  (1901)  : 
For  early  cases  of  pulmonary  tuberculosis. 
Capacity:  16. 
Terms  :  $14  per  week. 

Physician  in  charge :  Howard  D.  Kemp,  M.  D. 
Lahl  Ghur,  The  Red  House,  is  a  private  sanatorium,  situ- 
ated at  Ste.  Agathe,  on  a  gentle  slope,  at  an  elevation  of  about 
1,300  feet.  The  buildings,  facing  south,  are  three  semi-detached 
cottages,  with  a  central  dining-room  and  sitting  rooms.  There 
are  electric  lights  throughout,  hot  and  cold  baths,  hot  water 
heating,  and  long  distance  telephones.  Veranda  life  is  provided 
for  throughout  the  year. 

Application  should  be  made  to  Dr.  Howard  D.  Kemp. 

145 


Toronto  Free  Hospital. 


Part  II 

SPECIAL  DISPENSARIES 


I.— THE  FUNCTION  OF  SPECIAL  DISPENSA- 
RIES AND  IMPORTANT  FEATURES 
IN   THEIR   ORGANIZATION 

EDWARD  O.  OTIS 

SUPERINTENDENT  OP  THE  BOSTON  DISPENSARY 


DISPEXSARIES    FOR    TUBERCULOSIS 

Dispensaries  exclusively  devoted  to  the  treatment  and  care 
of  tuberculous  patients  are  of  recent  origin,  one  of  the  first 
having  been  established  by  Calmette,  of  Lille,  France,  whose 
work  and  aims  still  stand  as  a  model  and  inspiration  to  those 
contemplating  similar  enterprises.  Since  that  time  many  such 
establishments  have  sprung  up  on  the  continent  of  Europe  as 
well  as  in  this  country. 

There  are  various  conceptions  of  what  an  anti-tuberculosis 
dispensary  should  be.  All,  however,  are  agreed  that  its  scope 
should  be  wider  than  that  of  an  ordinary  clinic  or  out-patient 
department.  The  majority  of  such  institutions  on  the  continent 
are  independent  establishments  and  occupy  separate  buildings, 
while  in  England  the  consumptive  hospitals  have  out-patient 
departments  which  may  be  considered,  in  a  general  sense,  to  be 
tuberculosis  dispensaries. 

Heretofore,  in  this  country  at  least,  it  has  always  been  the 
custom,  and  for  the  most  part  is  now,  to  treat  tuberculous 
patients  in  the  general  medical  clinics,  and  only  from  a  medical 
standpoint.  They  were  examined  more  or  less  thoroughly  and 
prescribed  for,  the  attention  devoted  to  them  depending  on  the 
interest  of  the  physician  in  the  patient  and  his  disease  and  the 
time  at  his  command.  It  is  obvious  that,  in  a  large  medical 
clinic,  a  tuberculous  patient  could  receive  but  scant  attention. 

With  the  great  interest  and  activity  in  the  relief  and  control 
of  tuberculosis  now  existing,  and  the  recognition  of  what  can 
be  accomplished  in  the  way  of  prevention  and  the  curability  of 
the  disease,  every  additional  measure  calculated  to  further  these 
objects  is  to  be  commended,  and  from  what  it  has  already  accom- 
plished in  the  short  time  of  its  existence  the  anti-tuberculosis  dis- 
pensary has  proved  itself  to  be  an  exceedingly  valuable  addition 
to  one's  armamentarium  in  the  tuberculosis  warfare,  and  has 
abundantly  justified  its  existence. 

The  role  of  the  anti-tuberculosis  dispensary,  as  formulated 
by  the  French,  is  threefold  :  prophylactic,  therapeutic  and  social ; 
under  social  being  included  material  aid  to  the  poor  consump- 
tive on  the  one  hand,  and  protection  of  the  public   from  the 

149 


SPECIAL  DISPENSARIES 

disease  on  the  other.  By  instruction  of  the  patient  as  to  the 
proper  disposal  of  his  sputum  and  in  regard  to  disinfection,  by 
showing  in  simple  language  how  to  avoid  contracting  the  dis- 
ease, that  it  is  curable,  and  in  what  way,  one  fulfils  the  prophy- 
lactic role.  The  therapeutic  role  is  fulfilled  by  the  more  directly 
medical  treatment  of  the  patient,  the  diagnosis,  prognosis,  and 
the  prescription  of  any  drug  that  is  considered  necessary.  The 
social  role  comprises  personal  investigation  of  the  patient  and 
his  home  by  a  special  visitor  or  trained  nurses,  providing  proper 
food  when  necessary,  and  in  other  ways  supplying  the  material 
wants  of  the  patient  as  the  emergency  of  the  special  case 
demands. 

This  latter  role — the  social — is  carried  out,  at  least  in  this 
country,  by  associations  already  established  in  a  number  of  cities 
for  the  prevention,  relief  and  control  of  tuberculosis,  and  such 
associations  work  in  close  touch  with  the  anti-tuberculosis  dis- 
pensary. Further,  they  assist  the  patient  in  being  admitted  to 
the  sanatorium  when  the  case  is  a  curable  one,  or  mto  a  con- 
sumptives' hospital  when  it  is  too  far  advanced  to  enter  a  sana- 
torium ;  and,  through  the  instrumentality  of  the  board  of  health, 
when  a  patient  becomes  a  menace  to  the  other  members  of  his 
household,  they  see  that  he  is  removed  to  some  institution. 

There  are  advantages  in  having  a  tuberculosis  clinic  under 
the  same  roof  with  a  general  dispensary,  as  well  as  in  devoting 
a  special  building  to  it  as  is  done  in  France  and  elsewhere.  In  tlie 
former  case  it  is  easier,  for  instance,  to  refer  to  other  depart- 
ments for  advice  and  examination,  to  the  laryngological,  the 
X-ray,  or  general  medical  department,  for  example ;  and  other 
departments  can,  in  their  turn,  refer  cases  to  the  tuberculosis 
room  for  an  opinion  or  examination.  The  expense,  moreover, 
is  far  less,  for  this  is  under  the  same  administration  with  the 
other  clinics,  and  all  the  machinery  of  the  general  dispensary 
can  be  utilized,  so  that  to  establish  a  tuberculosis  department  in 
an  already  existing  dispensary  a  staff  of  physicians  has  only  to 
be  appointed  and  one  or  several  rooms  set  apart  for  the  purpose. 
snd  even  a 'single  room  can  be  made  to  do.  House  visitation 
through  a  special  visitor  or  district  nurses  can  as  well  be 
conducted  from  a  department  of  this  kind  as  from  a  special 
establishment.  Such  is  the  plan  of  operation  at  the  Boston 
dispensary,  and  it  has  worked  successfully. 

On  the  other  hand,  a  separate  establishment  emphasizes  the 

150 


SPECIAT.  DISPENSARIES 

importance  of  the  cure  and  control  of  the  disease,  and  lends 
dignity  to  the  work.  Moreover,  larger  facilities  can  be  afforded 
in  increased  room,  and  the  construction  of  the  building  can  be 
especially  directed  to  the  treatment  of  this  one  disease.  Ventila- 
tion, disinfection,  special  methods  of  treatment,  can  all  receive 
careful  consideration  ;  more  ample  facilities  for  laboratory  work 
can  also  be  offered  in  the  way  of  animal  experimentation, 
bacteriology,  and  other  lines  of  special  research.  In  such  a  build- 
ing an  ofifice  for  the  visitor  or  district  nurse  would  find  a  place. 
Another  room  might  be  devoted  to  the  exhibition  of  various 
material  bearing  upon  the  causes,  prevention  and  cure  of  tuber- 
culosis, such  as  photographs  of  unsanitary  tenement-houses  and 
bed-rooms,  statistics  graphically  illustrated,  methods  of  obtain- 
ing fresh  air  and  devices  for  utilizing  existing  conditions  for 
the  same,  models  of  tents,  photographs  of  sanatoriums,  and  very 
many  other  exhibits,  as  will  readily  suggest  themselves. 

In  a  large  city  one  or  more  special  tuberculosis  dispensaries 
on  this  extensive  scale  might  become  of  inestimable  value  as  a 
great  anti-tuberculosis  center. 

The  simplest  equipment  of  the  tuberculosis  dispensary  should 
consist  of  a  separate  waiting-room  and  receiving  or  consulting- 
room  v/here  histories  are  taken,  together  with  the  pulse,  tempera- 
ture, respiration  and  weight ;  several  small  examining  rooms ; 
a  small  room  for  the  examination  of  the  sputum  and  other 
bacteriological  investigations ;  a  dark  room  for  laryngoscopic 
examination,  unless  a  throat  department  exists  in  the  same  build- 
ing ;  and,  possibly,  an  X-ray  room.  Rooms  should  be  well 
ventilated  and  periodically  disinfected.  .  Circumstances  would 
determine  the  arrangement  of  the  personnel  of  the  staff',  but  as 
the  careful  examination  of  the  consumptive  requires  consider- 
able time,  there  should  at  least  be  several  skilled  assistants  while 
the  clinic  is  going  on. 

To  formulate  the  objects  of  such  a  dispensary  my  own  ex- 
perience and  thought  would  suggest  the  following: 

(i)  As  complete  an  investigation  of  the  patient  as  possible, 
including  history,  physical  and  bacteriological  examination,  and 
when  the  diagnosis  is  doubtful,  the  tuberculin  test  and  an  X-ray 
examination. 

(2)  Investigation  of  the  patient  and  his  surroundings  at  his 
home,  including  the  hygienic  condition  of  his  domicile. 

(3)  Instruction  both   of  the  patient  and   his   household   in 

151 


SPECIAI.  DISPENSARIES 

personal  and  domiciliary  hygiene,  and  the  safe  disposal  of  the 
sputum. 

(4j  The  free  supply  to  poor  patients  of  pocket  and  house 
spittoons. 

(5 J  Securing  entrajice  into  sanatoriums  for  curable  cases,  and 
into  consumptives"  hospitals  for  incurable  ones  when  they  can- 
not be  properly  treated  at  home ;  or,  when  neither  is  possible,  to 
treat  the  patient  at  his  home  as  well  as  the  conditions  will  permit. 

{6)  Aiding  poor  patients  to  obtain  suitable  food  and  other 
articles  necessary  for  their  proper  care. 

(7)  Affording  opportunity  to  physicians  to  send  their  poor 
patients  for  diagnosis  when  desired  as  well  as  advice  and 
assistance  in  treatment. 

(8)  The  examination  and  oversight  of  patients  who  have 
returned  from  sanatoria. 

(9)  Opportunity  for  the  scientific  investigation  and  study  of 
tuberculosis  and  various  methods  of  treatment. 

(10)  Clinical  instruction  to  students  and  physicians  in  the 
examination  of  tuberculous  patients. 

Of  course,  as  has  been  mentioned  above,  some  of  these 
objects  are  already  fulfilled  b}^  tlie  existing  associations  for  the 
relief  and  control  of  tuberculosis.  They  investigate  the  patient 
and  his  home ;  the}'  supply  him  with  food  and  other  needed 
articles,  and  obtain  mone}'  with  which  to  send  him  to  a  sana- 
torium or  hospital.  And  the  association  of  this  nature  in  Bos- 
ton, at  least,  is  proposing  to  investigate  and  look  after  those 
patients  discharged  from  the  state  hospital  for  consumptives 
at  Rutland. 

After  an  experience  of  several  years  with  such  a  clinic,  the 
writer  is  profoundly  impressed  with  the  great  good  that  can  be 
accomplished  by  it,  and  believes  that  the  time  will  come  when 
entirely  separate  establishments  of  this  kind  will  be  founded  in 
every  large  city  and  that  they  will  play  no  insignificant  part  in 
the  general  crusade  against  consumption. 

Edward  O.  Otis. 


152 


II.— SPECIAL    DISPENSARIES    IN    THE 
UNITED    STATES 

Arranged  in  alphabetical  order,  according  to  cities. 


BALTIMORE,   BOSTON,    CHICAGO 


BALTIMORE,  Maryland. 

Out-Patient  Department,  Johns  Hopkins  Hospital, 
Xorth  Broadway : 

A  new  building  devoted  to  the  tuberculosis  work  of  the 
out-patient  department  has  been  made  possible  by  a  gift  of 
S20,ooo  from  Henry  Phipps,  of  Pittsburgh.  The  plans  for  this 
building  contemplate  a  class  room  and  small  examining  rooms 
en  the  first  floor,  with  a  library  and  special  work  rooms  above. 
A  special  medical  officer  will  be  detailed  for  service,  and  a  nurse 
to  look  after  the  patients  in  their  homes. 

BOSTON,  Massachusetts. 

Tup.KRCULOsis  Clinic,  Boston  Dispensary,  Bennet  and  Ash 
Streets : 

Every  day,  9-1 1  A.  M. 

Physician  in  charge :  Edward  O.  Otis,   M.   D. 

There  are  no  charges. 
Children  and  adults  are  treated  in  separate  classes.  There 
are  no  nurses  especially  for  consumptives,  but  the  fourteen  dis- 
trict nurses  visit  such  cases  as  w^ell  as  other  patients.  Dr.  Otis 
has  three  assistants  in  the  Tuberculosis  Clinic,  and  there  are 
district  physicians  to  treat  patients  not  able  to  go  to  the  dis- 
pensary. Printed  instructions  are  given  to  patients  and  it  is 
planned  to  supply  sputum  cups  for  use  at  home.  Of  the  29,438 
new  patients  in  the  dispensary  last  year  275  were  treated  in  the 
Tuberculosis  Clinic. 

CHICAGO,  Illinois. 

Dispensaries  oe  the  Committee  on  the  Prevention  oi? 

Tuberculosis  oe  the  Visiting  Nurse  Association 

OF  Chicago  (1903)  : 

Central  Office:  1414  Unity  Building,  79  Dearborn  Street. 

]\Iedical  Director:  Arnold   C.   Klebs,   M.   D. ;  Assistant 

Secretary,  Caroline  Hedger,  M.  D. 
There  is  a  physician  in  charge  of  each  district  office,  a 
general    consulting   stafif   of   seventeen   members,    and 
nineteen  nurses  for  visiting  the  homes. 
Advice  is  free. 
The  Tuberculosis  Committee  has  established,  in  co-operation 
with  the  Bureau  of  Charities,  a  special  district  service  for  poor 
tuberculosis  patients.     In  the  district  offices  of  the  Bureau  of 

155 


CHICAGO 

Charities  rooms  are  set  aside  and  utilized  by  the  district  physi- 
cians as  consultation  offices.  Every  case  of  manifest  or  sus- 
pected tuberculosis  coming  to  the  notice  of  the  committee  or  the 
lelief  agencies  associated  with  it  is  referred  to  the  office  of  the 
district  in  which  he  resides.  Then  the  patient  is  visited  at  home 
by  either  a  charity  worker  or  one  of  the  district  nurses,  for  the 
purpose  of  ascertaining  the  patient's  condition  and  that  of  his 
home,  of  which  a  report  is  made  to  the  district  physician.  The 
patient  is  also  instructed  as  to  sputum  disposal,  general  hygiene 
and  similar  matters.  All  patients  able  to  be  out  of  bed  are  then 
sent  to  the  district  office,  where  at  fixed  hours  they  are  seen  by 
the  physician  in  charge,  who  examines  and  advises  them.  He 
also  visits  bed-ridden  patients  in  their  homes  and  directs  the 
nurses  as  to  special  requirements.  He  reports  each  case  and 
makes  recommendations  to  the  central  office  in  regard  to  removal 
to  hospital,  transportation,  disinfection,  supplies  and  relief. 

The  intention  of  the  committee  is  primarily  to  educate, 
through  trained  assistants,  the  patients  and  their  families,  and 
in  this  way  to  improve  insanitary  conditions  in  the  homes.  The 
treatment  of  patients  is  undertaken  only  on  general  lines  (open- 
air,  over-feeding  and  specific  hygienic  directions)  ;  for  special 
treatment  patients  are  referred  to  other  dispensaries.  In  the 
education  of  patients  and  their  families  preference  is  given  to 
repeated  personal  interviews  rather  than  to  printed  circulars. 

Over  400  patients  were  treated  in  this  way  during  the  first 
eight  months  after  the  establishment  of  the  system. 

The  addresses  of  the  district  offices  are  as  follows : 

Central  District,  1500  Wabash  Avenue. 
South  Central  District,  291  East  Thirty-first  Street. 
Stock  Yards  District,  716  West  Forty-seventh  Place. 
Woodlawn  District,  337  East  Sixty-third  Street. 
Englewood  District,  333  West  Sixty-third  Street. 
West  Side  District,  181  West  Madison  Street. 
Northwestern  District,  1235  Milwaukee  Avenue. 
Ravenswood  District,  Foster  Avenue  and  E.  Ravenswood  Park. 
North  Shore  District,  Foster  Avenue  and  E.  Ravenswood  Park. 
Northern  District,  1140  North  Halsted  Street. 
Lower  North  District,  365  Wells  Street. 
Southwest  District,  946  South  Ashland  Avenue. 


156 


CT^EVliLAND 


CLEVELAND,  Ohio. 

TuBivRCULOSis    Dispensary,    Wh;stern    Resi:rve    Medicai. 
College,  corner  St.  Clair  and  Erie  Streets  (August, 
1904)  : 
Daily,  3  to  6  p.  m. 

Physicians  in  charge :  Drs.  T.  H.  Lowman,  G.  W.  Moore- 
house,  T.  B.  Austin. 
Advice  is  free;  a  prescription  fee  of  10  cents  is  charged 
when  medicines  are  needed. 

The  entire  time  of  one  nurse  is  available  for  visiting  patients 
in  their  homes,  and  part  of  the  time  of  several  others.  Sputum 
cups  and  pocket  flasks  are  supplied,  and  printed  as  well  as  oral 
instructions  are  given. 


157 


MINNEAPOLIS 


MINNEAPOLIS,  Minnesota. 

Clinic  for  the  Tuberculous  Poor,  Medical  Department 
of  Hamline   University,   Fifth   Street  and   Seventh 
Avenue,  South  (April,  1904)  : 
Monday  and  Thursday :  i  to  2  p.  m. 
Physicians  in  charge :  F.  T.  Poehler,  M.  D.,  and  C.  H. 

Bradley,  M.  D. 
There  are  no  charges. 
By  co-operation  with  the  Tuberculosis  Department  of  the 
Associated  Charities  it  is  possible  to  send  a  nurse  to  the  home. 
Printed  instructions  are  supplied  and  sputum  receptacles  for 
the  pocket  and  for  use  at  home.  Twenty  patients  were  treated 
in  the  special  clinic  in  the  first  six  months  of  its  existence. 

Free  Dispensary  Eor  Tuberculosis,  University  of  Minne- 
sota   (organized  September,   1903;  opened  January, 
1904)  : 
18 10  South  Washington  Street. 
Monday,    Wednesday,    Thursday    and    Saturday,    12    to 

I  p.  M. 
A  committee  of  five  physicians  is  in  charge,   of   which 

Henry  L.  Ulrich,  M.  D.,  is  chairman. 
There  are  no  charges. 
In  the  first  ten  months  of  the  special  clinic  for  tuberculosis 
fifty  patients  were  treated.  By  co-operation  with  the  Tubercu- 
losis Department  of  the  Associated  Charities,  sputum  cups  and 
printed  instructions  are  provided  and  a  nurse  is  available  for 
visiting  patients  in  their  homes.  The  Associated  Charities,  in 
turn,  can  secure  from  this  dispensary  an  expert  diagnosis  in 
all  doubtful  cases  coming  to  their  attention.  There  is  a  well- 
equipped  laboratory  for  bacteriological  and  experimental  work. 
In  addition  to  the  usual  clinical  history  of  the  patients  informa- 
tion in  regard  to  their  social  and  industrial  conditions  is 
recorded. 


158 


JTONTREAL.    XEW    HAVEX 


MONTREAL,  Canada. 

A  Special  Dispensary  for  the  treatment  of  tuberculosis 
was  opened  on  Xovember  2,  1904,  by  the  Montreal  League  for 
the  Prevention  of  Tuberculosis  (see  page  254)  at  691  Dorches- 
ter Street.  Three  physicians  are  in  attendance.  Foods,  as  well 
as  medicines,  will  be  supplied  free  of  charge,  and  visits  will  be 
made  to  the  patients  in  their  homes. 

NEW  HAVEN,  Connecticut. 

Tuberculosis  Clinic,  New  Haven  Dispensary: 
Tuesday,  3  p.  m. 

Physician  in  charge :  H.  ]Merriman  Steele,  M.  D. 
There  is  no  charge  for  advice. 

The  special  clinic  was  established  in  the  fall  of  1903.  Printed 
instructions  are  given  to  patients  and  sputum  cups  are  provided. 
There  is  as  yet  no  visiting  nurse,  but  it  is  planned  to  develop  the 
department  as  rapidly  as  possible,  until  it  shall  include  all  the 
features  recognized  as  desirable. 


159 


NKW   YORK 

NEW  YORK  CITY,  New  York. 

Clinic  of  the  Department  of  Health  for  the  Treat- 
ment OF  Pulmonary  Diseases  (March,  1904)  : 
967  Sixth  Avenue. 

Director:  Hermann  M.  Biggs,  M.  D. 
Associate  Directors :  J.  S.  BilHngs,  Jr.,  M.  D.,  and  S.  A. 

Knopf,  M.  D. 
Daily,  except  Sunday:  10  to  12  a.  m.  and  2  to  4  p.  m.  ; 

Monday,  Wednesday  and  Friday,  also  8  to  10  p.  m. 
Advice  and  medicine  are  free. 

The  Municipal  Clinic  is  housed  in  a  new  building  especially 
designed  for  the  purpose,  adjoining  the  headquarters  of  the 
Department.  The  building  contains  a  registration  room,  drug 
room,  two  waiting  rooms,  an  X-ra}^  room,  throat  department, 
and  two  clinic  rooms,  for  male  and  female  patients,  respectively, 
each  with  its  examination  room. 

Physical  examination,  repeated  sputum  examinations  and, 
when  required.  X-ray  examination,  may  all  be  used  in  making 
the  diagnosis,  in  order  to  guard  against  missing  incipient  cases. 

Instructions,  both  verbal  and  by  means  of  circulars  printed 
in  nine  or  ten  languages,  are  given  as  to  the  nature  of  the 
disease,  and  the  necessary  personal  and  hygienic  precautions 
to  be  taken  to  prevent  the  infection  of  others.  Paper  sputum 
cups  are  supplied  to  needy  cases.  A  special  staff  of  trained 
nurses  visits  the  patients  at  their  homes  to  see  that  the  instruc- 
tions are  being  observed,  that  the  sanitary  surroundings  are 
satisfactory,  and  that  such  assistance  is  given  as  is  required. 
Suitable  cases  are  referred  to  charitable  organizations  for  as- 
sistance. Every  effort  is  made  to  prevent  the  infection  of  the 
children  in  the  family  and  to  bring  about  the  removal  tO'  hospi- 
tals or  sanatoriums  of  the  dispensary  patients  who  require  such 
care. 

Double  reference  cards,  one-half  to  be  filled  out  and  given 
to  the  patient,  the  other  to  be  sent  to  the  Department  of  Health 
bearing  the  patient's  name  and  address,  are  furnished  to  physi- 
cians, charitable  organizations,  or  any  one  else  who  has  occasion 
to  use  them.  If  the  patient  does  not  report  within  a  given  time 
he  is  visited  from  the  dispensary. 

The  number  of  patients  seen  between  the  opening  of  the 
Clinic,  March  i,  and  September  15,  was  1,837. 

160 


Tent  at  Bellevue,  Showing  Proximity 
TO  River. 


Patient  from  the  Bellevue  Clinic  on 
Fire  Escape. 


NEW  YORK 

Out-Patiknt     Department     of     BeeeEvue     Hospital 
(December,  1903)  : 
Foot  of  East  Twenty-sixth  Street. 
Special    clinic    for    tuberculosis,    daily    except    Sunday,. 

from  I  to  4  p.  M. 
Director:  James  Alexander  Miller,  M.  D. 
Attending  Physicians :  Haven  Emerson,  M.  D. ;  Frederick 

L.  Keyes,  M.  D. ;  Wm.  S.  Cherry,  M.  D. ;  F.  Grosvenor 

Goodridge,  M.  D. 
Nurse  in  charge :  Miss  Annie  Damer. 

The  proper  regulation  of  the  home  conditions  is  especially 
emphasized.  Two  visiting  nurses  are  attached  to  the  clinic  and 
close  co-operation  with  the  physicians  and  with  relief  societies 
is  obtained.  Milk  and  eggs  are  given,  as  a  part  of  the  treatment, 
after  thorough  investigation  has  established  the  need  of  such 
assistance.  Printed  instructions  and  sputum  cups  are  dis- 
tributed. In  some  instances  reclining  chairs  and  sleeping  bags 
are  given  for  open-air  treatment  on  the  roofs  and  fire-escapes. 
Tent  cottages  have  been  erected  upon  the  hospital  grounds  for 
favorable  cases  who  cannot  obtain  suitable  sanatorium  or  home 
treatment.  About  fifty  new  cases  are  received  each  month.  The 
total  number  of  cases  treated  since  the  opening  of  the  clinic 
(ten  months)  is  440. 

The  accompanying  illustrations  of  devices  resorted  to  by  the  director  of  the  special  clinic 
at  Bellevue  first  appeared  in  connection  with  an  article  by  Dr.  Brannan  in  the  Medical  hlews  of 
September  24,  1904. 

GouvERNEuR  Dispensary,  Gouverneur  Slip,  New  York  City 
(October,  1903)  : 
Special  class  for  tuberculous  patients. 
Monday,  Wednesday  and  Friday,  11  to  i. 
Clinical  assistants  in  charge  of  tuberculosis  work ;  Stella 

S.  Bradford,  M.  D.,  and  N.  Gilbert  Seymour,  M.  D. 
There  are  no  charges  for  treatment. 

During  the  first  five  months  of  this  special  class  the  average 
number  of  patients  per  month  was  13.  During  September,  1904, 
85  patients  were  treated,  30  of  whom  were  new.  Simple  verbal 
advice  is  given.  Sputum  cups  are  supplied  for  use  at  home. 
Since  June  the  work  in  the  clinic  has  been  supplemented  by 
the  services  of  a  visiting  nurse. 

162 


Patient  from  the  Bellevue  Clinic  in 
Extension  Chair  on  Roof. 


Patient  from  the  Bellevue  Clinic  in 
Hammock  on  Roof. 


Ni:w   YORK 

Harlsm  Hospital  Dispe^nsary    (August,   1904)  : 
Foot  of  East  1 20th  Street. 
Monday,  Wednesday  and  Friday,  3  p.  m. 
Physician  in  charge:  Charles  H.  Moak,  M.  D. 
There  are  no  charges. 

The  special  class  here  has  just  been  started,  and  the  organiza- 
tion is  not  yet  complete.  Verbal  instructions  only  are  given,  and 
there  is  no  arrangement  for  visiting  patients  in  their  homes. 
In  the  first  six  weeks  after  the  opening  of  the  special  clinic 
about  fifty  tuberculous  patients  were  treated. 

Post-Graduate  Hospitat  DispiJnsary: 
Dr.  Russell's  Class,  Room  4. 
Daily :  7  to  8.30  a.  m.  and  7  to  8  p.  m.  ;  patients  reporting 

for  the  first  time  should  go  at  the  evening  hour. 
Medicine  and  advice  are  free. 

Dr.  Russell  accepts  for  treatment  adults  in  any  stage  of 
pulmonary  tuberculosis,  provided  it  is  imcomplicated  with  any 
other  disease,  and  provided  the  patients  are  able  to  go  to  the 
dispensary  twice  a  day  and  to  secure  suitable  food,  clothing  and 
shelter.  During  1903  there  were  treated  in  this  class  74  cases ; 
in  the  first  nine  months  of  1904,  62. 

The  treatment  consists  largely  of  careful  questioning  and 
advice  in  regard  to  food,  sleep,  and  general  habits  of  life.  The 
Russell  Emulsion  of  mixed  fats  is  administered  at  the  dispensary. 
Each  patient  is  required  to  report  at  the  dispensary  twice  each 
day,  and  the  hours  are  arranged  for  the  convenience  of  working 
men  and  women.  Irregularity  of  attendance  or  failure  to  obey 
directions  is  followed  by  dismissal  from  the  class. 

Physicians  of  the  city  are  invited  to  send  suitable  cases  and 
to  visit  the  class  any' Sunday  morning  at  nine.  Reports  of  the 
results  obtained  are  published  annually  in  the  Post-Graduate 
Journal,  by  a  committee  of  inspection  appointed  by  the  Executive 
Committee  of  the  Post-Graduate  Medical  School  for  the  purpose 
of  reviewing  Dr.  Russell's  work. 

An  annex  to  the  Dispensary  has  just  been  added,  in  the 
shape  of  a  small  hospital  for  twelve  patients  in  the  advanced 
stages  of  the  disease.  The  hospital  is  at  322  East  Nineteenth 
Street. 

164 


NKW    YORK,    ORANGE 

The  Prksbyterian  Hospital  Dispensary,  Madison  Ave- 
nue and  70th  Street : 
Daily,  except  Sunday  and  legal  holidays,  1.30  to  3  p.  m. 
Eight  physicians  are  in  charge. 

Ten  cents  is  collected  for  each  prescription  from  those 
able  to  pay ;  otherwise  no  charge  is  made. 
Children  and  adults  are  treated  in  separate  classes.  There 
are  three  nurses  who  visit  patients  in  their  homes.  Printed  in- 
structions are  distributed  and  sputum  cups  are  supplied.  Dur- 
ing 1903  the  total  number  of  patients  treated  for  tuberculosis 
was  410. 

A'andercilt  Clinic  (January,  1903),  Amsterdam  Avenue 
and  Sixtieth  Street : 

There  is  no  special  department  for  tuberculous  patients 
attending  the  Clinic,  but  for  nearly  two  years  a  certain  number 
of  them  have  been  given  special  attention.  The  work  was 
begun  by  Dr.  J.  A.  Miller,  now  in  charge  of  the  Tuberculosis 
Classes  in  the  Out-Patient  Department  of  Bellevue,  in  January 
of  1903,  and  it  is  now  being  carried  on  by  Dr.  Linsly  R. 
AMlliams,  under  the  supervision  of  Prof.  James  of  the  Depart- 
ment of  ^Medicine. 

Patients  are  given  verbal  and  printed  instructions  about  the 
care  of  sputum  and  they  also  receive  advice  as  to  diet  and 
hygiene.  Sputum  pouches  are  supplied.  A  special  record  of 
their  clinical  history  is  kept  and  a  report  of  the  home  and 
linancial  conditions.  All  patients  in  Manhattan  are  visited  and 
further  instructed  by  a  nurse  supplied  by  the  Presbyterian 
Hospital.  Patients  from  other  boroughs  are  visited  by  the 
Board  of  Health  nurses. 

Between  February  i,  1904,  and  the  end  of  October  415  new 
cases  were  treated,  of  whom  125  were  under  care  at  the  latter 
date. 

ORANGE,  New  Jersey. 

Tuberculosis  Department,  Orange  Memorial  Hospital 
Dispensary  (April,  1904),  224  Essex  Avenue: 
Daily,  12  to  i  p.  m. 

Chief  of  the  Clinic :  Henry  A.  Pulsford,  M.  D. 
Those  who  can  afford  to  do  so  pay  ten  cents  at  their  first 
visit :  there  are  no  other  charges. 
The  special  clinic  was  organized  April  1,  1904.    One  visiting 
nurse  is  attached  to  this  department  and  printed  instructions  are 
distributed  to  patients. 

165 


PHII.ADELPHIA,   PROVIDENCE 


PHILADELPHIA,  Pennsylvania. 

The  Henry  Phipps  Institute  maintains  a  free  clinic  at 
238  Pine  Street. 

(See  page  249.) 

Rush   Hospital   Dispensary,  Lancaster  Avenue   and   33d 
Street : 
Daily :  2.30  p.  m. 
Physicians  in  charge :  John  D.  McLean,  M.  D. ;  Charles 

A.  E.  Codman,  M.  D. ;  Ross  K.  Skillern,  M.  D. 
Advice  is  free. 

There  is  no  provision  for  visiting  the  homes  or  for  exercis- 
ing any  further  influence  on  the  patients  after  they  have  left  the 
dispensary.    About  500  patients  were  treated  last  year, 

PROVIDENCE,  Rhode  Island. 

Out-Patient  Department  oe  Pulmonary  Tuberculosis 
OE  THE  Rhode  Island  Hospital  (Jnly,  1900)  : 
Monday  and  Thursday :  9  a,  m. 

Physician  in  charge:  Jay  Perkins,  M.  D. ;   assistant  phy- 
sician, Pearl  Williams,  M.  D, 
Advice  is  free, 

A  special  clinic  for  tuberculosis  was  established  July  i,  1900. 
In  the  year  ending  September  30,  1903,  the  patients  examined  or 
treated  for  tuberculosis  numbered  1,337,  of  whom  1,074  were  old 
patients,  263  new.  Three  nurses,  employed  by  the  Providence 
District  Nursing  Association,  visit  the  homes,  as  requested. 
Printed  instructions  and  sputum  cups  are  supplied. 

All  patients  applying  in  the  other  departments  of  the  dis- 
pensary are  referred  here  when  they  show  anv  indications  of 
tuberculosis.  The  chief  difficulties  encountered  are  the  lack  of 
provision  for  patients  needing  sanatorium  or  hospital  treatment, 
and  the  securing  of  proper  nourishment  at  home. 


166 


SCRANTON,    WASHINGTON,    WORCESTER 

SCRANTON,  Pennsylvania. 

Free  Dispensary  for  Diseases  of  the  Lungs,  207  Linden 
Street  (January,  1903)  : 
Wednesday  and  Saturday :  7  to  9  p.  m. 
Advice  is  free. 

In  charge  of  four  physicians  and  conducted  by  the  Scran- 
ton  Society  for  the  Prevention  and  Cure  of  Consump- 
tion. 

About  one-third  of  the  patients  last  year  were  treated  for 
tuberculosis.  Printed  instructions  are  given  to  patients,  sputum 
cups  are  supplied,  and  a  nurse  visits  those  who  need  special  care. 
"Of  the  fifty-three  consumptives"  (treated  in  1903),  reads  the 
first  annual  report  of  the  society,  "it  is  probable  that  nearly  all 
have  been  so  taught  that  they  will  not  spread  the  disease  to 
others." 

WASHINGTON,  District  of  Columbia. 

A  Free  Dispensary  for  the  examination  and  treatment  of 
those  who  are  suffering  from  tuberculosis  or  suspect  that  they 
may  have  contracted  it  has  been  opened  by  the  Associated 
Charities'  Committee  on  the  Prevention  of  Consumption,  at 
605  Four-and-Half  Street,  S.  W. 

WORCESTER,  Massachusetts. 

TuBERCUEOsis   Ceinic,   Out-Patient   Department,   City 
Hospital  (January  i,  1904)  : 
Wednesday  and  Saturday :  9  to  10  a.  m. 
Physician  in  charge :  Albert  C.  Getchell,  M.  D. 
There  is  no  charge  for  advice. 

Special  diet  when  the  patient  is  unable  to  procure  it  for  him- 
self, and  whatever  care  in  the  home  is  indispensable,  are  pro- 
vided by  co-operation  with  the  Associated  Charities,  the  District 
Nurse  Association  and  the  Worcester  Association  for  the  Relief 
and  Control  of  Tuberculosis.  A  small  card  folder  of  "rules  for 
consumptives"  is  given  to  patients  and  sputum  cups  are  supplied 
for  use  at  home.  Residents  of  Worcester  County  who  desire 
admittance  to  the  State  Sanatorium  are  examined  here.  The 
number  of  patients  treated  in  the  Tuberculosis  Clinic,  in  the  first 
nine  months  after  it  was  opened,  was  46. 

167 


Part  III 

THE   TUBERCULOUS   INSANE 


I.— TENT  TREATMENT   FOR   TUBERCULOUS 

INSANE 

A.  E.  MACDONALD,  LL.B,,  M.D. 

MEDICAL  SUPERINTENDENT,  MANHATTAN  STATE  HOSPITAL,   EAST. 


TEXT  TREATMENT  FOR  THE  TUBERCULOUS 
INSANE 

\The  illustrations  which  accompany  this  article  are  from  the  Annual  Report  for  1903  of  the 
Manhattan  btate  Hospital,  East,  the  use  of  the  original  plates  having  been  kindly  accorded  by 
the  General  Manager  of  the  State  Printer's  Office,  Mr.  Charles  M.  Winchester,  Jr.) 

That  consumptive  insane  patients  may  be  kept,  and  treated, 
to  their  advantage  and  incidentally  to  the  advantage  of  their 
fellow-inmates,  in  canvas  tents,  and  throughout  the  several  sea- 
sons of  the  year,  has  been  demonstrated  in  the  recent  history  of 
the  Alanhattan  State  Hospital,  East.  The  experiment  upon  the 
success  of  which  this  claim  is  advanced  has,  at  the  date  of  this 
writing,  September  30,  1904,  covered  a  period  of  forty  months, 
the  camp  having  been  first  established  and  occupied  by  patients 
on  June  5,  1901. 

The  serious  problem  of  caring  for  this  class  of  patients  had, 
prior  to  that  date,  embarrassed  this  particular  hospital  with 
others,  and  with  added  seriousness  from  the  fact  that  insane  men 
had  to  be  dealt  with,  and  that  the  form  of  construction  of  the 
hospital  buildings  was  such  that  no  smaller  wards  or  sections, 
adaptable  to  necessary  isolation,  were  available.  In  all  hospitals 
for  the  insane  the  form  of  insanitv  properly  constitutes  the  pre- 
vailing basis  for  classification,  modified,  of  course,  b_y  such  sec- 
ondary considerations  as  the  patient's  physical  condition,  pro- 
gress toward  recovery  or  the  reverse,  and  other  elements.  To 
set  up  another  standard — the  presence  of  a  bodily  diseased  con- 
dition— and  to  assemble  all  patients  suffering  from  it,  without 
regard  to  any  associated  conditions  or  circumstances,  is  a  dif- 
ficult undertaking,  involving,  among  other  departures  from 
routine  practice,  the  association  of  disturbed  and  dangerous  with 
demented  and  harmless  patients,  and  so  on  through  all  the  inter- 
mediate degrees.  This,  too,  has  been  accomplished,  and  with 
unexpected  ease  and  success. 

]\Iy  first  intention  and  expectation  were  that,  by  possibility, 
the  consumptive  insane  patients,  or  a  majority  of  them,  might 
be  removed  from  contact  with  their  fellows  for  some  months, 
perhaps  as  many  as  five  months,  during  the  milder  season  of  the 
year,  with  the  attendant  advantage  of  freeing,  for  the  time  being, 

171 


TUBERCULOUS  INSANE 

corresponding  space  in  the  permanent  buildings,  and  affording 
opportunity  for  disinfection  and  renovation. 

Study  was  made  of  the  arrangement  of  hospital  tents  and 
accessories  in  the  exhibit  by  the  United  States  Army  Hospital 
Corps  at  the  Pan-American  Exposition  then  in  progress  at  Buf- 
falo, and  visits  were  made,  for  the  same  purpose,  to  army  posts 
in  the  vicinity  of  New  York  City. 

The  camp  first  established  consisted  of  two  large  dormitory 
tents — twenty  by  forty  feet — each  containing  twenty  beds,  with 
smaller  tents  of  different  shapes,  about  ten  by  ten  feet,  for  the 
accommodation  of  the  nurses,  the  care  of  hospital  stores,  pantries 
and  a  dining-tent  for  such  patients  as  were  able  to  leave  their 
beds  and  tents,  and  go  to  the  table  for  their  meals.  Running 
water  was  secured  by  means  of  underground  pipes,  and  the  safe 
disposition  of  waste  and  sewage  was  also  specially  provided  for. 

As  has  been  said,  it  was  expected  to  continue  the  camp  only 
through  the  summer  and  as  far  into  the  autumn  as  favorable 
weather  might  render  justifiable.  But  when  in  the  late  autumn 
it  was  found  that  the  favorable  experience  continued,  it  was  de- 
cided to  attempt  to  carry  the  experiment,  on  a  modified  scale, 
into,  or  even  through,  the  approaching  winter.  The  Camp,  as 
first  established,  had  been  placed  upon  an  elevated  knoll  adjacent 
to  the  river  side  and  purposely  exposed  to  the  full  force  of  the 
summer  breezes.  For  the  winter  experiment  its  site  was  re- 
moved to  the  center  of  the  island,  where  trees  and  buildings 
interposed  to  act  as  a  wind-break  to  the  severe  storms  from  the 
east  and  northeast  which  are  tO'  be  expected  in  that  locality. 
The  number  of  patients  was  reduced  to  twenty,  those  in  whom 
the  disease  was  most  active  being  retained  and  the  others  being 
returned,  for  the  time  being,  and  much  against  their  will,  to  the 
buildings.  One  large  tent  sufliiced  for  the  housing  at  night 
of  the  reduced  number  of  patients,  and  one  was  set  apart  as  a 
sitting-room  for  day  use,  with  the  accessory  tents  before  men- 
tioned,' and  large  stoves  were  placed  in  them,  here  and  there, 
with  wire  screens  surrounding  them  to  protect  the  patients,  and 
a  liberal  use  of  asbestos  and  other  fireproof  material  and 
arrangements  for  the  prevention  of  fire.  Better  resistance  to  the 
force  of  the  expected  gales  was  secured  by  stronger  and  more 
numerous  guy-ropes  and  anchorages,  and  slatted  wooden  mova- 
ble pathways  were  prepared  which  might  furnish  means  of  pas- 
sage between  the  tents  when  snow  and  slush  should  come.     Thus 

173 


TUBERCULOUS  INSANE 

equipped  the  coming  of  midwinter  was  awaited  with  the  ex- 
pectation that  the  twenty  survivors  must  sooner  or  later  follow 
their  fellows  into  the  shelter  of  the  permanent  buildings,  and 
with  every  preparation  made  for  immediate  evacuation  and  re- 
treat. The  most  sanguine  hope  did  not  go  beyond  this  point. 
As  the  weeks  passed,  however,  and  the  patients  continued  com- 
fortable, evacuation  was  deferred  until  a  severe  storm  occurred. 
Then  it  was  found  that,  in  spite  of  high  wind  and  snow,  a  more 
equable  temperature  had  been  maintained  and  less  discomfort 
caused  in  the  tents  than  in  the  hospital  wards  most  exposed  to 
the  force  of  the  gale.  From  that  experience,  followed  by  other 
confirmatory  ones,  resulted  the  reconsideration  of  the  design  to 
evacuate  the  Camp. 

To  make  a  long  story  short,  it  has  remained  in  continuous 
use,  not  only  throughout  the  first  winter,  but  through  the  two 
succeeding  winters  and  intervening  seasons,  up  to  the  date  of  the 
present  writing.  The  scope  of  its  employment  has  been  gradu- 
ally enlarged  until  all  patients  in  whom  there  are  active  mani- 
festations of  phthisical  processes — an  average  of  forty-three  out 
of  a  total  census  of  about  two  thousand — are  isolated  therein, 
and  there  has  been  parallel  enlargement  of  the  elements  of 
the  plant. 

While  not  properly  coming  within  the  scope  of  this  writing, 
it  may  not  be  out  of  place  to  make  brief  mention  of  the  fact  that 
the  success  of  the  first  established  Camp — that  for  the  tubercu- 
lous insane — has  led  to  the  extension  of  the  tent  treatment  for 
the  insane,  at  this  hospital,  to  several  other  classes  of  patients. 
Following  the  experiences  and  results  of  the  first  winter,  as 
above  summarized,  the  tuberculosis  Camp  was  in  the  spring  re- 
enlarged  to  its  full  capacity,  and  has  remained  in  full  use  ever 
since,  so  that  every  patient  showing  the  least  activity  of  symp- 
toms is  not  only  afforded  for  himself  the  advantage  of  the 
outdoor  treatment,  but  is  removed  from  possible  danger  of  in- 
jurious influence  upon  his  neighbors.  Each  year  also  an  addi- 
tional camp  for  another  class  of  the  insane  has  been  put  in  com- 
mission:  one  in  1901,  Camp  "B,"  for  demented  and  uncleanly 
men,  many  of  them  bedridden,  whose  emancipation  from  the 
wards  was  a  great  gain,  both  for  themselves  and  for  the  hospital 
conditions  generally;  one  in  1902,  Camp  "C,"  for  feeble  and 
decrepit  women,  who  were  losing  the  benefits  of  outdoor  life  be- 
cause the  high  levels  and  long  stairways  of  the  buildings  were  a 

175 


TUBERCULOUS  INSAXTv 

prohibition  to  egress  and  ingress ;  one  in  1903,  Camp  "D,"  for 
convalescing  patients,  and  those  mainly  from  among  the  work- 
ers in  the  printing  office,  the  shoe  shop,  and  the  tailor  shop^ 
so  that  they  might  enjoy,  in  .the  non- working  hours,  and 
tspecially  at  night,  the  advantages  of  which  their  indoor  em- 
plovments  deprived  them  during  the  greater  portion  of  the  day ; 
and,  lastly,  one  in  1904,  Camp  '■£,''  of  forty  beds,  as  an  acces- 
sory to  the  acute  hospital  service,  where  patients  for  the  most 
part  confined  to  bed,  and  suffering  from  various  concurrent  dis- 
eases added  to  their  insanity,  find  an  agreeable  and  beneficial 
change  from  the  ordinary  surroundings  of  the  hospital  sick- 
room. In  all,  during  the  summer  just  past,  and  at  this  date,  two 
hundred  and  sixty  patients  have  been,  and  are.  undergoing  tent- 
treatment,  an  average  of  forty-three — all  consumptives — re- 
maining in  Camp  "A"  throughout  the  year,  and  the  others  as 
long  as  favorable  weather  continues.  In  1903  Camp  "B"  con- 
t'nued  in  commission  from  Jime  i  to  November  30,  Camp  "C^ 
from  June  i  to  October  15,  Camp  "D"  from  June  i  to  Novem- 
ber 30.  and  Camp  ■'■£''"  was  opened  on  July  i,  1904,  and.  with 
the  several  others,  is  still  f  September  30)  in  use. 

It  is  not  proposed  to  follow  here  in  detail  the  history  of  the 
Camp  for  tuberculous  patients.  Neither  the  purpose  of  this 
communication  nor  the  lim.itation  as  to  space  will  permit  of  it, 
and  the  reader  who  may  desire  further  information  in  that  direc- 
tion must  be  referred  to  the  annual  printed  reports  of  the  hospi- 
tal, and  to  special  articles  by  members  of  the  hospital  staff  which 
have,  from  lime  to  time,  appeared  in  the  Journal  of  Insanity  and 
other  professional  pviblications.  It  must  suffice  to  summarize 
results.  The  isolation  of  the  tuberculous  patients  has  reduced 
to  a  minimum  the  danger  of  infection  of  other  patients  and  of 
emplovees.  The  patients  themselves  have  suffered  no  injury  or 
hardship,  but  have,  on  the  contrary,  been  unmistakably  bene- 
fited. This  is  shown,  among  other  ways,  by  a  decrease  in  the 
death-rate  from  pulmonary  tuberculosis,  both  absolute  and  rela- 
tive, and  by  a  marked  general  increase  in  bodily  weight,  amount 
ing  in  the  case  of  one  patient  to  an  actual  doubling  of  weight — 
from  eightv-three  to  one  hundred  and  sixty-six  pounds — in 
fourteen  months  of  Camp  residence. 

I  prefer  to  advance  these  proofs,  as  they  depend  upon  fig- 
f.res  which  are  not  capable  of  manipulation,  rather  than  the 
usual  percentage  calculations  of  '"improvements,''  and  especially 

17G 


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Pi 
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TUBKRCUIvOUS  INSANE 

of  "recoveries,"  which  are  for  the  most  part  notoriously  unrelia- 
ble. Several  patients  whose  mental  improvement  permitted  of 
their  absolute  discharge  have  left  the  hospital  with  the  pulmon- 
ary disease  also,  to  all  appearances,  completely  arrested.  Others 
whose  condition  in  the  latter  respect  was  similar  have  been  re- 
turned, their  insanity  still  continuing,  from  the  tent  to  the  ward, 
and  after  periods  extending  in  individuals  as  long  as  two  years, 
continue,  as  far  as  can  be  found  upon  most  thorough  investiga- 
tion, immune  from  reappearance  of  the  disease.  In  other  such 
cases  again,  but  these  are  fewer  in  number,  confinement  to  the 
wards  has  resulted  in  return  of  phthisical  manifestations ;  but 
even  in  this  most  unfavorable  class  the  benefits  of  the  outdoor 
system  have  been  demonstrated,  for  invariably  improvement  has 
again  speedily  followed  upon  their  prompt  return  to  the  Camp. 
Mental  improvement  has  as  a  general  rule  been  the  concomitant 
of  physical,  not  only  among  the  patients  in  the  Tuberculosis 
Camp,  but  also  in  the  others,  and  in  the  former  class  this  has 
been  somewhat  of  an  anomaly.  My  experience,  and  I  think  that 
of  others,  has  been  that  when  phthisis  and  insanity  co-exist  they 
are  apt  to  alternate  as  to  the  prominence  of  their  several  mani- 
festations— the  mental  symptoms  being  more  pronounced  whilst 
the  physical  are  in  abeyance,  and  vice  versa.  Under  the  tent- 
treatment  we  have  found  a  general  disposition  toward  accord  in 
the  manifestations,  improvement  in  both  respects  proceeding 
concurrently,  and  some  of  the  discharges  from  the  hospital 
which  gave  most  satisfaction  to  us  at  the  time,  and  most  assur- 
ance for  the  patient's  future,  were  of  inmates  of  the  Tuber- 
culosis Camp. 

The  mental  improvement,  even  in  cases  where  recovery  was 
not  to  be  looked  for,  has  been  a  gratifying  feature  of  the  Camp 
experiment,  and  depending  largely,  as  it  has,  upon  the  patient's 
satisfaction  with  his  new  surroundings,  has  served  to  dispel  one 
of  the  doubts  with  which  the  experiment  was  undertaken.  It 
was  apprehended  that  not  only  might  the  patients  themselves 
resent  their  transfer,  but  that  similar  objection  might  come  from 
their  relatives  and  friends,  since  innovations,  even  progressive 
ones,  are  apt  to  be  frowned  upon  by  those  who  constitute  the 
majority  in  the  clientele  of  a  public  hospital  in  a  cosmopolitan 
city.  Even  at  the  outset,  however,  the  protests,  whether  from 
patients  or  their  friends,  were  surprisingly  few,  and  latterly 
they  have  been  more  apt  to  arise,  if  at  all,  over  the  patient's 
return  to  the  buildings  when  that  became  necessary.     Through- 

178 


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TUBERCULOUS  INSANE 

out  the  winter  months  constant  and  anxious  inquiries  have  been 
made,  both  by  patients  who  had  been  in  the  non-tuberculosis 
camps  and  by  their  visitors,  as  to  how  early  in  the  spring  the 
former  might  expect  to  resume  their  camp  life. 

The  question  of  medication  may  in  the  present  writing  be  dis- 
missed with  a  very  brief  reference.  It  has  been  found  unneces- 
sary to  extend  it  greatly,  and  it  has  been  limited  mainly  to  the 
treatment  of  symptoms.  Stimulation — alcoholic  and  the  like — 
has  been  found  of  but  little  demand  or  use,  and  the  quantities 
consumed — always  under  individual  medical  prescription — have 
been  insignificant.  On  the  other  hand  the  dietary  has  been  made 
as  liberal  as  the  imposed  restrictions  of  the  State  Hospital  sched- 
ule have  permitted,  both  in  the  way  of  regular  diet  and  extras, 
and  in  the  leading  essentials — milk  and  eggs — private  donations 
have  supplemented  the  regular  supply.  But  dependence,  after 
all,  has  been  mainly  placed  upon  rigid  isolation  and  disinfection, 
and  upon  the  unlimited  supply  of  fresh  air.  As  an  interesting 
incidental  fact  it  may  be  mentioned  that  not  only  the  patients, 
but  also  the  nurses  living  in  the  Camp  have  enjoyed  almost  com- 
plete immunity  from  other  pulmonarv  diseases.  Not  a  single 
case  of  pneumonia  has  developed  in  the  Camp  in  its  existence  of 
over  three  years,  though  it  caused  131  deaths  in  the  hospital 
proper  in  that  time.  The  "common  colds"  so  frequent  among 
their  fellows  living  upon  the  wards,  or  in  the  Attendants'  Home, 
have  been  unknown  among  the  tent-dwellers. 

The  popular  idea  that  the  consumptive  is  a  doomed  man  un- 
less he  can  at  once  abandon  home  and  family  and  business  and 
betake  himself  to  some  remote  region  would  seem  to  be  nega- 
tived by  our  \\''ard*s  Island  experience.  So  also  with  the  strenu- 
ous claims  for  high  altitude.  The  Ward's  Island  Camp  is  but  a 
few  feet  above  the  tide-water  level,  its  site  is  swept  in  winter 
by  winds  of  high  velocity,  coming  over  the  ice-bound  waters  of 
the  rivers  and  the  sound  which  >  surround  it,  and  it  suffers  as 
much  as,  or  more  than,  any  other  part  of  the  city  of  New 
York  from  the  trying  changes  of  temperature  and  humidity 
which  are  so  characteristic  of  its  climate.  If,  in  spite  of  all  these 
drawbacks,  what  has  been  done  can  be  done,  and  that  for  insane 
patients,  what  may  not  be  hoped  from  the  extension  of  the  same 
methods  to  the  ordinarv^  consumptive  of  sound  mind,  anxious 
for  recovery,  and  capable  of  giving  intelligent  assistance  in  the 
struggle?  A.  E.  Macdonaed, 

September  30,  1904. 

180 


II.— HOSPITALS  FOR  THE  INSANE  IN  WHICH 

SPECIAL  PROVISION  IS  MADE  FOR 

CONSUMPTIVES 

Arranged  in  alphabetical  order,  according  to  states. 


HOSPITALS   FOR  THE;   INSANEj 


CALIFORNIA 

Mendocino  State  Hospital  for  Insane,  Talmage  : 

Seven  tents  have  just  been  erected  tor  the  tuberculous 
patients.  Three  are  for  dormitories,  accommodating  fifteen 
patients,  one  is  a  sitting-room,  one  a  kitchen,  one  a  lavatory, 
and  one  is  for  attendants.  Most  of  the  food  will  be  supplied 
from  the  main  building,  but  a  kitchen  has  been  provided  for 
the  purpose  of  preparing  the  extra  food  that  will  be  required. 
It  is  planned  to  keep  patients  in  the  tents  throughout  the  winter. 
The  Superintendent  is  E.  W.  King,  M.  D. 


DELAWARE 

State  Hospital  for  the  Insane,  Farnhurst: 

In  1903  a  separate  building,  with  accommodations  for  twenty 

patients,  was  provided,  exclusively  for  the  tuberculous  inmates 

of  the  institution. 

This  is  the  first  instance  of  the  erection  and  equipment,  by 

a  state  insane  hospital,  of  a  new  building  especially   for  this 

purpose.    The  construction  cost  was  about  $1,000  per  bed.  There 

is  a  sun  parlor  at  each  end  of  both  floors,  and  the  building  is 

thoroughly  equipped  with  modern  apparatus. 

The  Superintendent  is  William  H.  Hancker,  M.  D. 


DISTRICT    OF    COLUMBIA 

Government  Hospital  for  the  Insane,  Washington  : 

A    separate    building    is    used    for    the    accommodation    of 
twenty  of  the  consumptive  men  in  this  hospital.     The  rest  of 
the  forty-five  or  fifty  tuberculous  patients  are  isolated  in  single 
rooms  or  small  wards  whenever  this  is  possible. 
The  Superintendent  is  William  A.  White,  M.  D. 

183 


Tuberculosis  Building,  Delaware  State  Hospital  for 
THE  Insane. 


HOSPITALS  FOR  THE  INSANE 

LOUISIANA 

State  Insane  Asylum,  Jackson  : 

Two  one-story  pavilions  for  the  white  male  and  white  female 
consumptives  of  this  institution  are  nearly  completed.  The 
building  for  women  will  accommodate  thirty-two  patients ;  the 
one  for  men,  forty.  Both  are  isolated  and  have  been  con- 
structed with  special  regard  to  thorough  ventilation. 

The  tuberculous  patients  will  be  kept  entirely  separate  from 
the  others ;  they  will  have  their  own  recreation  grounds,  will 
receive  special  treatment  and  diet,  and  will  lead  an  out-of-door 
life  as  much  of  the  time  as  possible. 

The  Superintendent  of  the  Insane  Asylum  is  George  A.  B. 
Hays,  M.  D. 

MARYLAND 

Springeield  State  Hospital  eor  the  Insane,  Sykesville: 

For  three  years  tuberculous  patients  have  been  kept  in  tents 
for  about  eight  months  during  the  year.  On  account  of  the 
high  rate  of  improvement  in  the  patients  under  this  regime  it  is 
planned  soon  to  extend  the  outdoor  treatment  throughout  the 
year. 

The  Superintendent  is  J.  Clement  Clark,  M.  D, 

MISSISSIPPI 

State  Insane  Hospital,  Jackson  : 

Separate  buildings,  accommodating  about  40  patients,  were 
set  aside  in  1897  for  the  consumptives  of  the  institution.  They 
are  brick  buildings  two  stories  in  height,  located  on  elevated 
ground. 

The  Superintendent  is  T.  J.  Mitchell,  M.  D. 

NEW  YORK 

Manhattan  State  Hospital,  East,  Ward's  Island  (a  state 
institution  for  the  insane)  New  York  City: 
Tuberculous  cases  are  isolated  in  tents.  In  the  winter  of 
1903-04  there  were  over  forty  patients  treated  in  this  way.  The 
system  of  tent  treatment  was  inaugurated  in  June,  1901,  and 
each  year  it  has  been  extended,  either  in  time  or  in  the  number 
of  patients  included,  until  at  present  all  the  active  cases  of 
tuberculosis  in  the  institution  are  kept  in  tents  throughout  the 
year. 

185 


HOSPITALS   FOR  THi:  INSANE 

The  colony  is  situated  on  sloping  ground  about  60  feet  above 
sea  level,  and  has  a  moderate  amount  of  shade.  The  soil  is  dry 
and  well  drained,  over  a  rock  bottom.  There  are  two  tents, 
accommodating  twenty  beds  each,  20  by  40  feet  and  14  feet 
high,  with  the  wall  6  feet  high.  A  smaller  square  tent  provides 
three  beds  for  critical  cases.  Similar  square  tents  serve  as 
dining-rooms,  while  smaller  ones  are  used  for  linen  rooms, 
storerooms  and  bath  rooms. 

It  has  been  found  that  the  tuberculous  insane  improve,  under 
this  system  of  care,  both  mentally  and  physically,  and  it  has  been 
adopted  in  other  states. 

Since  the  retirement,  on  October  i,  of  Dr.  A.  E.  Macdonald, 
the  acting  superintendent  has  been  J.  T.  W.  Rowe,  M.  D. 


WiivivARD  State;  Hospitai,  for  the;  Insane;,  Willard,  Se;ne;ca 
County : 

During  the  summer  of  1903  life  m  a  tent  colony  was  tried 
for  about  fifty  tuberculous  men  and  women.  Each  of  the  two 
sets  of  tents  included  a  dormitory  for  twenty  or  twenty-five  pa- 
tients, a  bathroom,  a  dining-room,  and  a  small  tent  for  storage. 
There  was  a  telephone  in  each  tent  and  running  water.  Here,  as 
on  Ward's  Island,  it  was  found  that  the  patients  liked  their  out- 
door life  and  gained  in  every  way.  The  experiment  lasted  from 
early  summer  until  extremely  cold  weather,  and  was  repeated 
and  extended  in  the  summer  of  1904.  It  is  hoped  to  extend  and 
develop  the  system  until  all  the  tuberculous  patients  can  be 
kept  out  of  doors  practically  throughout  the  year. 

The  Superintendent  is  Robert  M.  Elliott,  M.  D. 


State  Hospitals  for  the  Insane,  at  MiddlETown^  Ogdens- 
burg  and  binghamton  : 

The  State  Commission  in  Lunacy  is  planning  the  erection, 
within  the  present  year,  of  a  large  pavilion  in  connection  with 
each  of  these  hospitals,  for  the  special  treatment  of  insane  per- 
sons suffering  from  tuberculosis.  They  are  designed  to  accom- 
modate 100  patients  each,  and  are  modelled  after  the  plans 
awarded  the  first  prize  in  the  contest  for  plans  for  the  King 
Edward  Sanatorium  in  England. 

186 


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HOSPITALS  FOR  THE  IXSAXE 

OHIO 

Columbus  State  Hospital  for  the  Ixsaxe: 

In  the  spring  of  1903  a  tent  camp  was  equipped  for  the  care 
of  twenty-four  women  affected  with  tuberculosis.  The  results 
were  so  satisfactory  that  the  camp  was  kept  open  until  Xovem- 
ber  5,  and  in  1904  was  increased  to  a  capacity  of  eighty-four 
patients,  Xot  only  were  most  of  the  patients  benefited  physi- 
cally by  the  outdoor  life,  but  many  of  them  also  improved 
mentally,  and  all  were  pleased  with  the  new  way  of  living. 

Two  large  tents,  for  sixteen  patients  each,  are  used  for  men, 
and  there  are  several  smaller  ones,  with  a  capacity  of  eight  each, 
for  women.  Patients  are  classified  in  the  camp  according  to  the 
stage  of  the  disease  and  according  to  their  mental  condition. 
Close  observations  are  made  on  each  patient  and  daily  records 
are  kept  of  his  mental  and  physical  condition,  in  connection 
with  records  of  the  climatic  conditions.  The  camp  is  lighted 
by  electricity  and  supplied  with  hot  and  cold  water,  and  con- 
nected by  telephone  with  the  main  office.  ]\Ieals  are  served  from 
the  main  kitchen  in  a  dining  tent.  An  interesting  fact  is  that  the 
expense  of  installing  the  six  tents  used  during  the  first  season 
and  the  cost  of  maintenance,  with  the  exception  of  food,  was 
only  $1,400. 

The  Superintendent  is  George  Stockton,  AI.  D. 

RHODE  ISLAND 

State  Hospital  for  the  Ixsaxe,  Howard  : 

At  this  institution  two  tents,  each  20  by  40  feet,  are  used 
each  year  from  May  until  December  for  tuberculous  patients. 
The  Superintendent  is  George  F.  Keene,  ]M.  D. 

VERMONT 
Vermont  State  Hospital  for  the  Insane,  Waterbury: 

A  separate  ward  building,  containing  twenty-two  beds,  for 
the  segregation  of  the  tuberculous  male  patients,  is  in  process  of 
construction  and  near  completion.  It  is  possible  and  perhaps 
probable  that  the  incoming  legislature  will  appropriate  money 
for  the  erection  of  a  similar  building  for  the  segregation  of 
female  patients. 

The  Superintendent  is  ]\Iarcello  Hutchinson.  AI.  D. 

]8« 


HOSPITALS   FOR  THi;  INSANE 

VIRGINIA 
Central  State  Hospital  for  the  Insane,  Petersburg: 

Tuberculous  patients  are  segregated  in  two  camps,  one  for 
the  male  and  one  for  the  female  patients.  These  camps  consist 
of  tents  of  various  sizes,  for  sleeping  apartments,  dining-rooms, 
bathrooms,  and  one  for  the  acute  sick.  They  are  located  on  a 
lawn  entirely  apart  from  all  other  patients.  The  number  of 
cases  in  the  two  camps  averages  between  sixty  and  seventy. 
The  camp  for  men  was  opened  in  May,  the  one  for  women  in 
July,  1904. 

The  Superintendent  is  William  Francis  Drewry,  M.  D. 


189 


^' 


Part  IV 
TUBERCULOUS  PRISONERS 


I.— THE   PREVENTION    AND   TREATMENT 

OF  TUBERCULOSIS  IN  PENAL 

INSTITUTIONS 

J.  B.  RANSOM,  M.D. 

PHYSICIAN  TO  CLINTON  PRISON,  DANNEMORA,  NEW  YORK 


THE  PREVENTION  AND  TREATMENT  OF  TUBER- 
CULOSIS  IN   PENAL   INSTITUTIONS 

Primarily  the  prevention  of  tuberculous  disease  in  penal  insti- 
tutions begins  with  the  early  life  history  of  the  juvenile  offender, 
which  is  not  within  the  province  of  this  article. 

Aside  from  this  feature  the  prevention  of  tuberculous  disease 
in  penal  institutions  presupposes,  ifirst,  proper  housing.  Tuber- 
culosis is  essentially  a  house  disease.  It  is  bred,  fostered  and 
propagated  in  a  larger  degree  through  the  housing  environment 
than  through  any  other  one  means.  An  inspection  of  the  penal 
institutions  of  this  country  will  show  that  the  housing  facilities 
of  the  majority  are  of  a  character  decidedly  favoring  the  develop- 
ment and  spread  of  tuberculosis.  The  location,  elevation,  ex- 
posure to  sunlight,  of  the  buildings  for  housing  and  manufactur- 
ings purposes,  and  the  sewage  and  drainage,  of  many  institu- 
tions are  defective  when  judged  from  the  tuberculosis  stand- 
point. 

The  second  great  factor  in  the  development  and  propagation 
of  this  disease  in  penal  institutions  is  cellular  confinement,  in 
both  the  regulation  and  the  punishment  cells,  especially  the 
dark  cells.  In  the  damp,  dark  corners  of  the  cells  of  most  insti- 
lions,  almost  never  visited  by  sunlight,  the  tuberculosis  germ 
lurks  and  propagates  itself  through  the  medium  of  the  cell  in- 
mates. Added  to  this  is  the  ancient  and  common  practice  of 
using  whitewash  as  a  cleansing  and  disinfecting  agent.  As  such, 
whitewash  is  a  delusion.  Observation  and  experiment  show 
that  whitewash  really  promotes  the  spread  of  tuberculous  dis- 
ease, or  it  may  do  so.  The  fine  scales  and  floating  particles  that 
emanate  from  the  dry  whitewash  when  disturbed  not  only  irri- 
tate the  bronchial  mucous  membranes,  but  they  are  also  carriers 
of  infection  to  the  point  iritated.  This  has  been  demonstrated 
to  my  entire  satisfaction  by  cell  scraping.  Certain  experiments 
with  lime  burners  also  go  to  show  that  lime  dust  is  favorable 
to  the  production  of  tuberculous  disease.  The  bucket  system, 
in  use  in  most  penal  institutions,  is  another  factor  in  the  produc- 
tion of  tuberculous  infection,  vitiating  as  it  does  the  atmos- 
phere of  the  cell  and  thus  producing  conditions  favorable  to 
germ  life. 

193 


tube;rculosis  in  prisons 

Still  another  factor  is  the  unsanitary  construction  and  un- 
cleanliness  of  workshops  and  factories  connected  with  these 
institutions.  Never  can  it  be  hoped  to  eradicate  tuberculosis 
from  the  penal  institutions  until  there  are  radical  improvements 
in  all  these  and  other  like  features  of  the  prison  housing  and 
grounds. 

The  buildings  connected  with  penal  institutions  should  be 
especially  constructed  with  a  view  to  proper  sanitation.  The 
grounds  should  be  well-drained,  the  sewage  system  complete, 
and  the  buildings  so  placed  as  to  admit  both  the  morning  and 
afternoon  sunlight.  They  should  have  high  ceilings,  large  win- 
dows, and  an  adequate  ventilating  system.  The  cells  should  be 
large,  well-lighted,  and  provided  with  water-closet  and  wash- 
basin. These  cells  should  be  constructed  of  steel,  and  a  wash- 
able paint  used  as  an  interior  finish.  The  cell  halls  should  be 
kept  scrupulously  clean,  and  at  stated  periods  washed  with  anti- 
septic solutions.  All  cells  vacated  should  be  disinfected,  and  no 
whitewash  used  about  the  prison  interior. 

Next  in  importance  to  the  housing  is  the  feeding,  clothing, 
and  body  hygiene  of  the  prison  population  in  insuring  a  high 
resisting  power  in  the  individual.  While  the  food  must  neces- 
sarily be  plain  and  simple  in  character,  it  should  nevertheless  be 
varied  to  suit  conditions  and  seasons.  It  should  be  nutritious, 
and  a  careful  balance  maintained  betAveen  the  proteid  and 
starchy  foods,  with  a  generous  admixture  of  fresh  vegetables. 

Especial  attention  should  be  paid  to  the  clothing  and  bath- 
ing of  penal  populations.  Spray  baths  should  be  given  at  fre- 
quent intervals ;  the  clothing  should  be  adapted  to  the  seasons, 
kept  clean  and  frequently  disinfected  by  dry  heat :  and  personal 
cleanliness  should  be  insisted  upon.  All  men  confined  in  penal 
institutions  should  be  permitted  to  exercise  at  some  period  of  the 
day  in  the  open  air. 

There  are  many  other  features  in  detail  which  might  be 
enumerated,  and  which  are  important  in  the  solving  of  the 
problem  of  the  prevention  of  tuberculosis  in  penal  institutions, 
but  those  indicated  are  the  chief  factors,  and  if  strictly  carried 
out  would  accomplish  much  toward  preventing  the  disease. 

The  first  step  in  the  intelligent  and  effective  treatment  of  the 
tuberculous  prisoner  is  the  introduction  into  all  the  penal  insti- 
tutions of  systematic  methods  of  examination,  which  will  make 
not  only  possible,  but  certain  as  may  be,  the  early  diagnosis  of 
the  disease.  .g^ 


TUBERCULOSIS  IN   PRISONS 

Under  the  methods  of  the  past,  and,  I  may  say,  mostly  of  the 
present,  the  tuberculous  may  be  found  scattered  through  every 
department  of  penal  institutions  unrecognized,  none  but  the 
most  advanced  and  self-evident  cases  receiving  special  treatment 
and  isolation.  Thus  the  majority  of  incipient  cases  go  slumber- 
ing on,  until  the  disease  has  so  far  advanced  that  recovery  is 
made  hopeless  in  many  cases  and  the  infection  is  consequently 
conveyed  to  many  other  persons. 

To  remedy  this  defect  a  law  should  be  enacted  making  it 
m.andatory  upon  the  physicians  of  all  jails  and  penal  institutions 
to  examine  every  man  upon  reception,  with  a  view  to  detecting 
every  case  of  tuberculosis,  no  matter  in  what  stage,  and  to  fill 
out  a  proper  certificate,  showing  the  condition  of  each  person 
examined,  a  copy  of  which  certificate  should,  in  jail  cases,  be 
submitted  to  the  court  of  trial,  in  order  to  hasten  the  trial  of  the 
tuberculous  person,  and  should,  in  case  of  commitment  to  penal 
institutions,  accompany  the  regular  commitment  papers. 

As  soon  as  an  adequate  system  of  identification  for  the  tuber- 
culous criminal  has  been  put  into  working  order,  the  whole 
problem  will  become  greatly  simplified.  When  once  the  prisoner 
is  found  to  be  tuberculous,  he  should  at  once  be  isolated  from 
the  general  population  and  subjected  to  observation.  If,  after 
observation,  it  is  found  that  his  disease  is  not  in  an  active  stage, 
that  his  general  condition  is  good,  that  he  is  not  coughing  or 
expectorating,  and  that  bacilli  are  not  present  in  his  sputa,  he 
can  safely  be  assigned  to  some  form  of  light  work  that  will 
admit  of  his  receiving  a  degree  of  air  and  sunlight,  and  not  ex- 
pose him  to  a  dusty  atmosphere.  His  case  should,  however, 
always  be  under  close  scrutiny,  with  a  view  to  anticipating  any 
renewed  activity  of  the  disease. 

If  the  disease  is  at  all  active  the  patient  should  be  admitted 
to  regular  hospital  treatment.  My  own  experience  leads  me  to 
believe  that  this  is  best  carried  out  in  large  open  wards  with 
high  ceilings,  admitting  an  abundance  of  sunlight  and  fresh  air. 

After  admission  to  the  wards  the  treatment  of  the  tubercu- 
lous prisoner  does  not  differ  materially  from  that  of  the  tuber- 
culous citizen,  except  that  there  are  certain  conditions  which 
arise  depending  upon,  and  peculiar  to,  the  prison  environment. 
The  subjective  effects  of  this  environment  are  the  element  of 
mental  depression  and  consequent  unstableness  of  the  nervous 
system,  caused  by  the  shock  of  arrest,  trial  and  imprisonment, 

196 


tube;rculosis  in  prisons 

and  the  enervating  effects  of  confinement  under  penalty.  These 
special  conditions  must  be  met  by  appropriate  treatment,  and 
this,  the  nerve  feature  of  the  tuberculous  prisoner,  requires  very 
much  more  attention  than  in  the  case  of  the  ordinary  citizen. 

The  objective  conditions  are  those  which  necessarily  arise 
from  the  effects  of  prison  discipline  upon  the  prisoner.  He 
must  conform  to  certain  fixed  rules  and  regulations,  and  there- 
fore a  full  degree  of  freedom  of  individual  action  cannot  be 
permitted  him.  Neither  can  he  receive  the  amount  of  outdoor 
,air  and  exercise  that  his  case  may  require,  as  only  at  certain 
hours  of  the  day  can  he  be  permitted  outside  Lhe  prison  walls. 

Fresh  air  and  sunlight  are  the  essential  factors  to  the  suc- 
cessful treatment  of  tuberculosis.  These  cannot  be  furnished  the 
prisoner  in  the  ordinary  cell  halls  of  a  prison.  However,  it  is 
my  belief,  derived  from  my  own  experience,  that  a  satisfactory 
system  can  be  devised  for  providing  these  requisites  to  the 
tuberculous  prisoner  by  separate  hospital  buildings,  provided 
with  large  open  wards,  so  arranged  as  to  admit  plenty  of  air  and 
sunlight,  and  with  sufficient  outdoor  grounds  for  open-air  treat- 
ment. The  advantages  of  the  open-ward  treatment  lie  in  the 
greater  facility  with  which  the  attendants  and  officers  may 
superintend  their  charges,  and  in  a  certain  amount  of  social 
intercourse  between  inmates  which  can  be  permitted  them  under 
this  system. 

As  an  illustration  of  the  advantages  to  be  derived  from  this 
method  it  may  be  well  here  to  describe  the  new  tuberculosis 
ward  now  in  use  in  Clinton  Prison,  in  connection  with  the 
regular  prison  hospital.  While  not  carrying  out  the  above  idea 
in  full,  it  is  a  great  step  in  the  right  direction,  and  has  decidedly 
proved  its  efficiency. 

This  ward  is  an  addition  to  the  regular  prison  hospital,  but 
separated  entirely  from  the  other  wards  by  the  main  central 
court  of  the  prison  hall  entrance.  It  is  situated  on  the  top  floor 
of  the  administration  building,  and  is  open  to  the  air  on  the 
eastern  and  western  sides  of  the  building,  thus  receiving  a  plenti- 
ful supply  of  light  and  air.  and  is  also  protected  on  the  northern 
side  by  the  main  buildings.  It  accommodates  forty-three  patients, 
and  is  provided  with  suitable  modern  sanitary  arrangements.  In 
connection  with  this  ward  is  an  eleven-bed  ward  for  the  treat- 
ment of  the  extremely  advanced  cases,  making  a  total  of  fifty- 
four  beds.  There  is  also  an  outdoor  sunning  and  exercise  court, 
which  is  provided  with  benches,  elevated  cuspidors  containing 


TUBERCULOSIS    IN    PRISONS 

antiseptic  solutions,  crematory  for  the  sputa  and  the  spit  cups 
with  which  each  inmate  is  provided,  running  spring  water,  and 
water-closet,  as  well  as  sufficient  shade,  afforded  by  a  few  trees, 
for  the  extremely  hot  summer  days. 

Treatment  of  the  patients  here  is  practically  divided  into 
three  phases :  physical,  medicinal  and  dietetic.  The  first  con- 
sists principally  of  simple  calisthenics  and  outdoor  exercise  in 
the  court  above  described,  morning  and  afternoon,  which  is 
required  of  each  patient  whenever  the  weather  and  his  condition 
permit. 

The  medicinal  treatment,  while  subordinated  to  the  physical 
and  dietetic,  is  nevertheless  an  essential  feature,  and  such 
medicaments  as  the  iodins,  creosote,  guaiacol,  ichthyol,  formalin, 
cod  liver  oil,  stomachics  and  tonics  are  used,  according  to  the 
requirements  of  the  different  cases.  The  ultra-violet  X-ray  has 
also  been  used  to  a  considerable  extent  with  beneficial  results. 
The  diet  is  prescribed  daily  by  the  physician,  and  is  furnished 
on  his  order  from  the  hospital  kitchen.  It  is  aimed  to  make  this 
diet  as  nutritious  as  is  consistent  with  available  means,  and  it 
includes  principally  cereals,  vegetables,  milk,  meat,  eggs  and 
fruits. 

It  is  also  intended  to  instruct  each  patient  thoroughly,  on 
admission,  as  to  the  necessary  sanitary  rules  peculiar  to  his 
disease,  as  regards  the  care  of  his  person,  clothing  and  sputa. 
He  is  required  to  conduct  himself  in  an  orderly  manner  and 
keep  his  person  clean  and  neat.  He  is  permitted,  within  certain 
limits,  to  mingle  and  converse  with  his  fellow  patients,  and  to 
play  checkers  and  dominoes  with  his  neighbors,  and  is  supplied 
with  plenty  of  good  reading. 

This  ward  is  in  charge  of  a  hospital  attendant — a  trained 
nurse — who  is  always  in  attendance  during  the  day.  While  it 
has  been  in  use  less  than  two  years,  the  results  shown  have  sur- 
passed all  anticipations.  Many  patients  are  admitted  in  an 
emaciated,  anaemic,  and  exhausted  condition,  apparently  to  live 
but  a  short  time,  but  a  few  days  under  this  systematic  routine 
and  treatment  make  a  manifest  improvement  in  them.  If  they 
carry  temperature,  it  gradually  subsides,  their  natural  color 
returns,  and  many  of  them  gain  materially  ni  weight.  A  goodly 
number  are  apparently  cured,  many  cases  are  arrested,  few  die; 
and  all  the  deaths  have  occurred  in  cases  which  were  received 
in  the  prison  in  the  last  stage  of  the  disease,  and  were  utterly 
hopeless  on  reception.    The  results  obtained  in  this  prison  by  the 

199 


turi;rcui,osis  in  prisons 

use  of  this  ward  lead  me  to  believe  that  this  method  of  treat- 
ment is  the  correct  one,  and  is  best  adapted  to  the  peculiar 
conditions  of  a  prison. 

A  separate  hospital  building  of  sufficient  capacity  to  accom- 
modate all  the  tuberculous  inmates  of  the  penal  institutions  of 
the  state,  provided  with  properly  fitted  wards,  modern  sanitary 
appliances,  and  outdoor  and  indoor  exercise  courts,  isolated 
completely  from  the  prison  population  proper,  presents  without 
question  the  solution  of  the  problem  of  the  treatment  and  pre- 
vention of  this  disease  in  the  penal  institutions  of  the  state. 

When  a  patient  has  arrived  at  an  arrested  stage  of  the  disease, 
he  can  advantageously  be  employed  at  some  light  work,  which,  I 
believe,  is  best  represented  by  light  gardening.  In  this  way  a 
sufficient  quantity  of  vegetables  and  relishes  can  be  raised  to 
supply  the  needs  of  the  patients,  they  receive  the  benefit  of  the 
exercise,  their  minds  are  diverted  into  a  healthy  channel,  which 
is  a  very  important  factor,  and  the  produce  supplied  by  such 
labor  undoubtedly  pays  for  the  extra  expense  incurred  in  the 
guarding  while  at  work. 

The  whole  solution  appears  to  me  to  lie  in  the  institution  of  a 
practical  system  such  as  outlined  above,  which,  briefly  stated, 
means  the  enactment  of  a  law  providing  for  the  early  diagnosis 
of  the  disease,  the  construction  of  a  modern,  isolated,  tubercu- 
losis hospital  building  of  sufficient  capacity,  and  the  compulsory 
transfer  to  it  of  all  established  cases  of  tuberculosis. 

J.  B.  Ransom. 


200 


II.— PENAL    INSTITUTIONS    IN     WHICH 

SPECIAL    PROVISION     IS     MADE 

FOR    CONSUMPTIVES 


cr. 


pe;nai,  institutions 

CONNECTICUT 

In  the  state  prison,  at  Wethersfield,  a  separate  ward  is 
reserved  for  consumptives. 

INDIANA 

In  the  State;  Re;formatory,  at  Indianapolis,  consumptives  are 
segregated  in  special  wards  and  sections  of  cells,  and  are  kept 
under  a  special  regimen  as  to  work  and  diet.  The  physician 
in  charge  is  H.  C.  Sharp,  M.  D. 

KENTUCKY 

The;  Prison  Hospital,  at  Frankfort,  cares  for  tuberculous 
prisoners  in  separate  wards.  There  is  separate  provision  in  this 
way   for  twenty   consumptives. 

MINNESOTA 

The  State;  Prison,  at  Stillwater,  was  the  first  prison  in  the 
country  to  adopt  modern  methods  in  the  treatment  of  tuber- 
culous convicts. 

Since  the  summer  of  1894  sputum  examinations  have  been 
made  in  all  suspected  cases,  and  when  tubercle  bacilli  are  found 
the  man  is  transferred  to  a  section  of  cells  reserved  for  such 
cases.  Special  care  is  taken  of  these  cells ;  they  are  inspected 
and  cleaned  daily.  Every  precaution  is  taken  against  the  spread 
of  infection.  The  consumptives  have  their  meals  in  their  cells, 
and  they  are  given  a  better  and  more  varied  diet  than  the  other 
convicts.  They  are  given  out-of-door  work  apart  from  their 
fellows,  and  when  too  ill  to  work  they  are  kept  out  of  doors  dur- 
ing working  hours,  both  summer  and  winter. 

In  this  prison,  out  of  a  population  of  800  convicts,  there  has 
not  been  one  death  from  pulmonary  tuberculosis  in  the  last  two 
years. 

The  prison  physician  is  B.  J.  Merrill,  M.  D. 

NEW  YORK 

CijNTON  Prison,  one  of  the  three  state  prisons,  is  located  at 
Dannemora,  in  the  Adirondacks.  Since  1895  there  has  been  a 
systematic  attempt  to  transfer  here  from  Auburn,  Sing  Sing, 

203 


PENAL  IXSTITUTIOXS 

Eastern  Xew  York  and  Elmira  Reformatories,  all  tuberculous 
prisoners,  for  the  purpose  of  isolating  them  and  giving  them 
special  treatment. 

A  small  isolation  ward  for  ii  cases  was  the  only  hospital 
provision  until  1902.  In  July  of  that  year  a  special  ward  ac- 
commodating 43  patients  was  constructed.  In  connection  with 
the  ward  is  an  exercise  court  where  the  patients  are  kept  in  the 
open  air  as  much  of  the  time  as  possible.  A  new  building,  with 
a  ward  of  100  bed  capacity,  is  now  under  construction.  In  addi- 
tion to  the  54  who  can  be  cared  for  in  the  existing  ward,  nearly 
200  other  consumptives  are  treated  in  cells  used  exclusively  for 
this  purpose. 

Dannemora  lies  on  one  of  the  eastern  spurs  of  the  Adiron- 
dack ]\Iountains,  at  an  altitude  of  1,500  feet.  It  is  protected 
by  mountains  on  the  north  and  west,  but  open  to  the  south  and 
east,  and  thus  is  weU  exposed  to  sunUght.  It  is  partly  sur- 
rounded by  dense  tracts  of  uninhabited  forest,  has  a  light  annual 
rainfall,  and  the  air  is  relatively  dr\-  and  sterile. 

The  prison  physician  is  Dr.  J.  B.  Ransom ;  assistant  physi- 
cian. Dr.  W.  N.  Thajer. 

SOUTH    CAROLINA 
State  Penitesttiamy,  Columbia: 

A  separate  building  for  the  tuberculous  prisoners  is  pro- 
jected. It  will  be  located  on  the  penitentiary  grounds,  and  will 
accommodate  about  fift\-.  It  is  hoped  that  it  will  be  ready  for 
use  in  August,  1905. 

The  superintendent  is  D.  J.  Griffith. 

TEXAS 
W\Tf3fE  Farm.  Hu^-tsville: 

The  Farm  was  established  in  1899,  for  the  isolation  and  care 
of  tuberculous  prisoners  in  the  Texas  penitentiaries.  It  is  lo- 
cated on  a  high,  well-drained  spot,  two  miles  northwest  of 
Hnntsville.  There  are  no  timbered  lands  near  the  buildings 
and  the  supply  of  air  and  sunshine  is  thus  unobstructed. 

Sergeants  and  camp  physicians  in  charge  of  the  convict 
farms  all  over  the  state  are  instructed  to  transfer  here  all  men 
suffering  with  tuberculosis  as  soon  as  the  disease  is  recognized. 

204 


PENAL  INSTITUTIONS 

Some,  also,  are  received  direct  from  the  jails.  During-  the  first 
three  years  the  total  number  treated  was  i8o,  of  whom  67  were 
Negroes,  65  white,  and  48  Mexicans. 

All  the  men  who  are  able  are  required  to  do  some  work, 
consisting  of  light  farming,  gardening,  poultry  and  stock  rais- 
ing. The  garden  products  supply  Wynne  Farm  and  the  Hunts- 
ville  Prison  and  leave  a  surplus  for  the  market.  It  is  believed 
that  the  Farm  will  soon  be  self-sustaining,  aside  from  the  ex- 
pense of  guarding  the  men. 

The  prison  physician  is  W.  E.  Fowler,  M.  D. 


205 


Part    V 

MUNICIPAL   CONTROL   OF    TUBERCULOSIS 


I.— ESSENTIAL  FEATURES  IN  A  MUNICIPAL 

SYSTEM  FOR  THE  CONTROL  OF 

TUBERCULOSIS 

HERMANN    M.  BIGGS,  M.D. 

MEDICAL  OFFICER  OF   THE  BOARD   OF    HEALTH   OF    NEW  YORK    CITY 


ESSENTIAL   FEATURES   IN  A  MUNICIPAL   SYSTEM 
FOR  THE  CONTROL  OF  TUBERCULOSIS 

(This  article  is  condensed  from  a  lecture  given  under  the  auspices  of  The  Henry 
Phipps  Institute  and  published  in  full  in  Tlie  Medical  Nen's,  February  20,  1904.) 

It  has  seemed  difficult  for  the  medical  or  lay  sanitary  authori- 
ties to  understand  that  with  the  new  knowledge  afforded  by  the 
observations  of  Koch  and  others  an  entirely  different  sanitary 
problem  was  presented  for  their  consideration,  and  that  for  its 
solution  new  methods  must  be  adopted.  Very  gradually  com- 
prehension of  this  simple  and  apparently  quite  self-evident  fact 
lias  forced  itself  upon  them.  It  may  be  said  now  to  be  an 
almost  universally  accepted  fact  that  some  kind  of  action  or 
supervision  is  justifiable  and  necessary,  and  the  only  difference 
of  opinion  is  as  to  the  extent  of  the  measures  which  should  be 
adopted  and  as  to  the  manner  of  their  enforcement. 

\Miat  measures,  then,  does  the  efficient  administrative  con- 
trol of  tuberculosis  require  ? 

I.  Notification  and  Registration. — The  compulsory  noti- 
ffcation  and  registration  of  all  cases  is  essential. 

The  fundamental  importance  of  this  measure  is  so  evident 
that  its  consideration  seems  hardly  necessary.  It  must,  of 
course,  appear  at  once  that  unless  there  is  a  system  of  compul- 
sory notification  and  registration  the  enforcement  of  any  uni- 
form measures  for  prevention  is  impossible.  Practical  experi- 
ence with  this  procedure  has  made  it  perfectly  clear  that  the 
objections  which  have  been  urged  against  it  are  without  force 
or  foundation. 

The  notification  of  a  case  of  tuberculosis  does  not  require  any 
action  on  the  part  of  the  authorities,  if  it  seems  reasonable  to 
assume  that  such  action  is  unnecessary.  The  very  fact  that  tu- 
Iberculosis  is  notified  by  the  attending  physician  as  a  communica- 
h\e  disease  has  the  greatest  educational  value,  and  justifies  the 
assumption,  in  those  instances  in  which  the  case  is  under  the 
supervision  of  a  private  physician,  that  reasonable  and  necessary 
precautions  for  the  protection  of  others  wall  be  taken.  If,  how- 
ever, the  consumptive  has  the  disease  in  an  infectious  stage  and 
is  without  a  home,  or  is  living  in  a  lodging-house,  or  in  a  poorly 
furnished  room,  or  in  a  family  in  a  tenement  house,  or  is  receiv- 
ing medical  advice  through  some  public  institution,  then  all  ob- 

209 


MUNIC:iPAI,  CONTROIv 

jection  to  the  interference  or  the  supervision  of  the  authorities 
is  removed,  and  in  the  interests  of  the  pubHc  such  interference 
and  supervision  become  necessary.  It  should  be  strongly  em- 
phasized that  the  mere  fact  of  notification  and  registration  has 
in  itself  a  very  powerful  educational  influence. 

2.  Fre;^  BactdrioIvOGicaIv  Examination  oe*  Sputum. — To 
facilitate  the  early  and  definite  diagnosis  of  all  cases  of  pulmon- 
ary tuberculosis,  the  sanitary  authorities  should  afford  facilities 
for  the  free  bacteriological  examination  of  the  sputum  in  all 
instances  of  suspected  disease. 

In  a  large  proportion  of  the  cases  of  early  disease  the  physi- 
cal signs  and  the  symptoms  are  not  sufficiently  definite  to  permit 
a  positive  diagnosis  by  the  general  practitioner.  An  expert  may 
easily  arrive  at  a  positive  conclusion,  but  the  general  practitioner 
remains  in  serious  doubt.  In  the  absence  of  a  positive  result 
from  an  examination  of  the  sputum,  the  attending  physician 
awaits  the  appearance  of  more  definite  signs,  and  thus  too  often 
loses  most  valuable  time,  for  these  more  definite  signs  mean 
further  extension  of  the  disease  in  the  lungs.  In  some  institu- 
tions, and  by  many  physicians,  the  positive  position  is  assumed 
that  no  case  is  to  be  regarded  as  tuberculosis  of  the  lungs  unless 
tubercle  bacilli  are  found  in  the  sputum.  It  is  hardly  necessary 
to  point  out  how  erroneous  and  dangerous  is  this  opinion. 

It  is  the  general  opinion  now  that  such  free  bacteriological 
examinations  should  be  made  by  the  authorities,  and  that  every 
convenience  and  facility  for  them  should  be  afforded.  It  is  a 
curious  fact,  in  this  connection,  that  large  numbers  of  physicians 
in  private  practice  who  are  unwilling  or  reluctant  directly  to 
report  cases  of  tuberculosis,  without  hesitation  send  specimens 
of  sputum  for  examination,  with  all  the  facts  in  relation  to  the 
patient  which  are  necessary  for  registration. 

3.  Educationai,  Measures. — It  is  difficult  to  overestimate 
the  importance  of  the  duties  of  the  sanitary  authorities  in  the 
education  of  the  medical  profession  and  of  the  people  on  the 
subject  of  tuberculosis.  Circulars  in  as  many  languages  as 
necessary,  designed  to  reach  different  classes  of  the  community 
and  covering  different  phases  of  the  subject,  should  be  widely 
distributed,  and  the  public  press  should  be  utilized  to  the  very 
largest  extent  in  the  diffusion  of  information.  The  circulars 
as  issued  should  be  given  to  the  press  for  general  publication. 

4.  The  Visitation  oe  Consumptives  in  Their  Homes. — 
An  important  part  of  the  work  of  the  authorities  consists  in  the 

210 


MUNICIPAL  CONTROL 

immediate  visitation  by  a  physician  or  trained  nurse  of  every 
case  of  tuberculosis  not  under  the  care  of  a  private  physician  or 
m  a  pubhc  institution,  as  soon  as  it  is  reported.  At  these  visits 
verbal  instructions  should  be  given,  and  printed  circulars  left 
for  the  information  of  the  patient  and  the  family.  At  the  same 
time  data  should  be  gathered  as  to  the  history  of  the  sick  person 
and  of  the  family,  its  social  condition  and  financial  income,  the 
number  of  persons  in  the  family  and  their  wages ;  the  number 
of  cases  of  tuberculosis  which  have  occurred,  the  probable  source 
of  infection  in  the  individual ;  the  sanitary  condition  of  the 
premises,  the  amount  of  air  space  for  each  person,  the  charac- 
ter of  the  light  and  ventilation,  the  precautions  being  observed 
and  the  possible  need  of  any  further  interference  on  the  part 
of  the  authorities.  In  the  course  of  these  visits  it  becomes  evi- 
dent in  many  instances  that  a  patient  should  be  removed  to  a 
hospital  or  sent  to  a  sanatorium  outside  of  the  city.  In  such 
instances,  if  possible,  the  patient  should  be  induced  by  persua- 
sion to  avail  himself  of  such  institutional  care  as  seems  desirable 
or  available.  If  the  patient  persistently  refuses  institutional 
care  forcible  removal  must  be  resorted  to  in  those  instances  in 
which  the  unsanitary  conditions  existing  render  it  necessary. 

5.  Disinfection. — The  disinfection  or  renovation  of  rooms 
or  apartments  which  have  been  vacated  by  consumptives  either 
by  death  or  removal  is  another  essential  part  of  the  system. 
Trained  medical  inspectors  should  be  sent  whenever  it  comes  to 
the  knowledge  of  the  authorities  that  premises  have  been  vacated 
by  death  or  removal,  and  proper  measures  adopted  to  enforce 
disinfection  of  the  premises  by  means  of  formaldehyde  gas,  or 
thorough  renovation.  In  those  instances  in  which  the  premises 
are  dirty  and  filthy,  and  the  walls  and  ceilings  are  in  bad  condi- 
tion, renovation,  to  be  performed  by  the  owners,  should  be  re- 
quired. If  necessary  for  this  purpose,  the  apartments  may  be 
vacated,  or,  if  already  vacant,  the  occupation  by  others  must 
be  prohibited  until  such  renovation  has  been  completed.  Car- 
pets, rugs,  clothing,  pillows  and  mattresses,  and  anv  bedding 
or  other  textile  fabrics,  which  cannot  be  properly  disinfected 
by  formaldehyde,  should  be  removed  by  the  authorities,  and  sub- 
jected to  steam  disinfection.  Disinfection  should  be  carried 
out  by  the  health  authorities  without  cost  to  the  occupants  or 
owners,  but  the  cost  of  renovation,  when  required,  should  be 
borne  by  the  owner  of  the  premises. 

A  serious  difficult}^  exists  in  this  connection  because  of  the 

211 


MUNICIPAL  CONTROL 

frequent  changes  of  residence  of  some  families  containing  con- 
iiumptives ;  and  as  the  famihes  become  constantly  poorer  on 
account  of  the  financial  loss  and  expense  entailed  by  the  illness, 
they  move  continually  to  a  poorer  and  poorer  class  of  tenements. 
It  is  often  impossible  to  trace  them,  or  to  obtain  information  of 
their  change  of  residence,  so  that  proper  disinfection  of  the 
apartments  may  be  ensured.  The  owners  of  the  property  may, 
of  course,  be  required  to  furnish  information  of  the  removal, 
but  there  is  danger  lest  this  course  may  eventually  entail  some 
hardship  on  the  poor  consumptive  in  rendering  it  more  difficult 
for  him  to  find  lodgings.  This  is  the  most  troublesome  prob- 
lem to  solve  which  has  been  found  in  this  connection  in  New 
York.  It  may  be  that  eventually  notification  by  the  owner  of 
the  removal  of  a  consumptive  will  be  necessary,  as  the  only  solu- 
tion of  this  difficulty. 

6.  Re;pEate;d  Visits. — Provision  should  be  made  for  making 
repeated  visits  to  cases  in  tenement  houses,  when  for  any  reason 
it  has  been  undesirable  or  impossible  to  remove  the  patient  to 
an  institution.  These  revisits  may  usually  be  best  made  by 
trained  nurses.  In  this  way  information  may  be  gathered  as  to 
changes  of  residence,  as  to  the  efficiency  of  the  precautions 
adopted  by  the  consumptive,  as  to  the  changes  in  his  physical 
condition  or  the  financial  resources  of  the  family,  and  as  to  the 
necessity  of  any  alteration  required  in  the  sanitar}^  treatment  of 
the  case. 

7.  DiLT. — Suitable  food,  especially  milk  and  eggs,  should 
be  provided  by  the  sanitar}^  authorities,  or  by  other  authorities 
having  supervision  of  such  afifairs,  in  those  instances  in  which 
the  families  are  in  such  destitute  circumstances  that  proper  or 
sufficient  food  cannot  be  obtained  by  them,  and  when  the  patient 
for  any  reason  cannot  be  removed  to  an  institution. 

8.  Institutions. — The  sanitary  authorities  should  provide, 
or  see  that  there  are  provided,  and  should  supervise,  three  classes 
of  institutions  for  consumptives : 

Free  Dispensaries. — In  these  free  dispensaries  medical  treat- 
ment for  ambulatory  cases  should  be  provided.  These  cases 
should  be  constantly  under  the  supervision  of  the  district  phy- 
sicians and  nurses  attached  to  the  dispensary.  When  necessary, 
not  only  medicines,  but  food,  should  be  furnished  free  by  the  dis- 
pensary to  the  consumptive  poor.  The  dispensaries  should  also 
act  as  clearing  houses  for  consumptives,  and  should  serve  as 
places  to  which  all  institutional  cases  on  their  discharge  from 

212 


MUNICII'AI,  CONTROI. 

■institutions  and  all  poor  cases  receiving  the  care -or  assistance 
of  charitable  organizations,  should  be  referred  for  medical  care. 
From  this  dispensary  suitable  cases  should  be  referred  to  either 
a  sanatorium  or  a  hospital,  as  seems  necessary. 

Hospitals  for  the  Care  of  Advanced  Cases. — It  is  not  neces- 
sary that  all  the  hospitals  for  the  care  of  advanced  cases  should 
be  directly  under  the  control  of  the  sanitary  authorities,  although 
they  should  exercise  a  general  supervision  over  these  institu- 
tions. It  is  necessary,  however,  at  least  in  a  very  large  city, 
that  the  authorities  should  have  control  of  at  least  one  institu- 
tion with  adequate  facilities  for  the  care  of  certain  varieties  of 
advanced  cases  of  the  disease,  which  it  may  be  necessary  to 
remove  forcibly  to  the  institution  and  retain  there. 

These  cases  are  of  several  types :  first,  those  who  are  dis- 
charged from  other  institutions,  because  they  are,  from  the  in- 
stitutional standpoint,  exceedingly  undesirable  patients,  or  be- 
cause they  have  violated  the  regulations  of  the  institution ;  sec- 
ond, cases  living  in  lodging  houses  and  inmates  of  public  insti- 
tutions not  having-  facilities  for  their  care,  who  are  unwilling 
to  enter  any  of  the  hospitals  which  are  available,  but  who  must 
be  provided  for  in  some  way ;  third,  cases  which  are  almost 
necessarily  sources  of  danger  to  the  other  members  of  their  fam- 
ily, by  reason  of  extraordinarily  unfavorable  sanitary  conditions, 
great  poverty,  or  overcrowding,  but  are  vmwilling  to  enter  an 
institution;  fourth,  numerous  cases  which  have  already  been 
under  the  care  of  an  institution,  and  which  become  for  some 
reason  dissatisfied  with  their  care  and  are  determined  to  return 
to  their  homes,  although  the  familv  is  unwilling  or  unable  to 
provide  properly  for  them. 

All  such  cases — homeless,  friendless,  dependent,  dissipated, 
and  vicious  consumptives — are  the  ones  likely  to  be  most  dan- 
gerous to  the  community.  They  must  be  provided  for  by  the 
sanitary  authorities  at  any  cost,  and  if  necessary  the  health 
authorities  must  intervene  to  remove  such  patients  by  force  to 
suitable  institutions  and  there  detain  them.' 

Sanatoriinns. — The  sanitary  authorities  should  provide,  or 
have  available,  proper  sanatoriums  in  favorably  situated  country 
districts  for  the  care  of  early  and  incipient  cases.  No  further 
comments  seem  necessary  on  this  phase  of  the  subject. 

9.  Regulations  for  Public  Institutions. — The  sanitary 
authorities  should  issue  regulations  applicable  to  public  institu- 

213 


MUNICIPAI.  CONTROL 

tions  as  to  the  care  of  consumptives.  The  admission  and  treat- 
ment of  such  patients  in  the  general  wards  of  general  hospitals 
should  be  prohibited,  and  all  public  institutions  caring  for  such 
patients  should  be  required  to  provide  separate  rooms  or  wards. 
These  regulations  should  apply  not  only  to  general  hospitals, 
but  also  to  the  hospitals  for  the  insane,  to  penal  institutions, 
homes  and  asylums.  Suitable  regulations  should  be  formulated 
in  regard  to  cases  occurring  among  the  teachers  or  pupils  in 
the  public  schools,  and  emplo37ees  in  factories,  workshops  and 
mercantile  establishments,  and  in  regard  to  occupations  of  a 
nature  likely  to  disseminate  the  disease. 

lo.  Ordinances  against  Expectoration. — The  sanitary 
authorities  should  enact  and  enforce  regulations  prohibiting 
spitting  on  the  floors  of  all  kinds  of  public  conveyances,  such 
as  street  cars,  steam  railroad  cars,  and  ferry-boats,  and  on  the 
floors  of  public  buildings  and  places  of  public  assembly,  such 
as  ferry-houses  and  depots,  and  in  the  halls  of  tenement  houses, 
in  theatres,  in  factories  and  in  workshops.  Spitting  on  the 
sidewalks  should  also  be  prohibited. 

When  we  have  educated  the  mass  of  people  up  to  this  view, 
so  that  this  habit  of  spitting  will  not  be  tolerated,  the  chief  factor 
in  the  solution  of  the  problem  of  the  prevention  of  tuberculosis 
will,  in  my  opinion,  have  been  found. 

A  number  of  measures  of  minor  importance  in  the  surveil- 
lance of  the  tubercular  diseases  have  been  in  operation  in  New 
York  City.  Among  these  ma}^  be  mentioned  the  semi-annual 
census  of  the  cases  of  pulmonary  tuberculosis  under  treatment 
in  public  institutions  in  the  city.  It  has  also  been  the  custom 
during  the  last  two  or  three  years  to  communicate  with  the  at- 
tending physician  in  cases  of  tuberculosis  which  have  been 
reported  through  the  sputum  examination  or  directly  and  to 
inquire  whether  the  patient  is  still  under  treatment,  and  if  so^ 
whether  improvement  has  taken  place  or  not,  and  whether  the 
physician  has  any  objection  to  a  visit's  being  made  to  the  patient 
if  he  is  not  at  that  time  under  his  observation.  If  the  physician 
replies  that  the  patient  has  passed  from  his  observation,  and  he 
has  no  objection  to  an  investigation  by  the  department,  an  effort 
is  made  to  locate  the  patient  and  determine  what  the  condition  is. 

Sanitary  cuspidors  are  supplied  by  the  department  through 
trained  nurses  for  the  use  of  very  poor  patients  in  the  tenement- 
house  districts,  and  large  numbers  of  these  cuspidors  have  also 
been  supplied  to  various  charitable  societies,  which  have  super- 

214 


MUNICIPAL  CONTROIv 

vision  of,  or  are  extending  help  to,  cases  of  consumption  in  their 
homes.  Large  numbers  of  circulars  of  information  have  also  been 
supplied  to  these  societies  for  distribution,  and  similar  circulars 
in  various  languages  have  been  furnished  to  various  labor 
unions  for  distribution  among  their  members. 

The  inspectors  of  the  Tenement  House  Department  and  visi- 
tors of  the  Charity  Organization  Society  and  other  private  socie- 
ties, report  to  the  Department  of  Health  any  cases  of  apparent 
tuberculosis  which  they  may  find,  and  these  are  investigated  by 
the  Department  of  Health. 

Attempts  have  been  made  to  secure  the  condemnation  by 
the  city  of  several  areas  in  the  tenement-house  districts  in  which 
tuberculosis  has  been  particularly  prevalent. 

One  minor  measure  which  has  been  found  of  much  service 
in  New  York  has  been  the  house-to-house  inspection  in  tenement- 
house  districts  by  women  physicians  in  the  search  for  unreported 
cases  of  tuberculosis.  Quite  a  large  number  of  such  cases  have 
been  found  in  this  way,  especially  among  the  foreign  population. 
It  is  also  of  the  greatest  importance,  in  this  connection,  that  the 
trained  nurses  and  medical  inspectors  should  know  the  language 
of  the  people  whom  they  are  visiting.  Great  care  has  been 
taken,  as  far  as  it  was  possible  under  the  civil-service  regula- 
tions, to  obtain  trained  nurses  and  physicians  who  speak  foreign 
languages.  We  have  now,  engaged  in  this  work,  nurses  who 
speak  French,  German,  Yiddish,  Russian,  Italian,  Chinese, 
Slovak  and  Polish. 

These  measures  include  the  more  important  provisions  of  a 
scheme  for  the  efficient  administrative  control  of  tuberculosis. 

In  its  main  and  most  important  features  such  a  plan  has  been 
in  force  in  New  York  City  for  a  number  of  years.  The  feasi- 
bility and  the  practicability  have  been  conclusively  demonstrated 
by  experience  in  the  second  largest  city  in  the  world.  In  only 
a  few  of  the  less  important  details  is  the  general  plan  as  now 
followed  in  New  York  wanting. 

Very  great  opposition  met  the  proposition  of  the  Department 
of  Health  to  undertake  this  work  in  the  beginning,  and  many 
difficulties  were  encountered  in  the  early  years  owing  to  this 
opposition.  But  experience  has  shown  that  the  obstacles  are 
largely  imaginary ;  that  the  harmful  results  which  were  pre- 
dicted as  certain  to  follow  have  failed  to  materialize.  Practi- 
cally no  serious  difficulties  are  encountered  in  carrving  on  the 
work.     The  difficulties  are  really  less  serious  than  those  encoun- 

215 


MUNICIPAL  CONTROL 

tered  in  connection  with  the  contagious  diseases.  There  has 
been  hearty  approval  by  the  majority  of  the  medical  profession, 
and  acquiescence  by  the  remainder. 

In  answer  to  the  question,  What  may  reasonably  be  expected 
from  the  enforcement  of  such  measures?  we  find  again  an 
answer  in  the  experience  of  New  York.  There  has  been  a  more 
rapid  fall  in  the  tuberculosis  death  rate  in  New  York  City  than 
in  any  great  city  in  the  world,  and  this  notwithstanding  the  fact 
that  the  conditions  in  many  respects  are  much  more  unfavorable, 
because  of  the  very  dense  population  in  the  great  tenement-house 
districts  of  the  city  and  the  large  element  of  foreign-born  popula- 
tion. Various  investigations  that  have  been  carried  on  by  the 
Department  of  Health  seem  to  substantiate  the  conclusion  that 
the  decrease  in  the  deaths  from  tuberculosis  is  a  real  one  and 
not  in  any  m.aterial  respect  merely  apparent.  It  is  not  at  all 
intended  to  indicate  that  the  whole  of  the  reduction  in  the  death 
rate  from  tuberculosis  in  New  York  City  has  been  the  result 
of  the  measures  directed  especially  against  this  disease,  for  many 
other  factors  have  undoubtedly  contributed  to  it,  but  I  do 
believe  that  the  very  great  and  rapid  fall  in  the  tuberculosis 
death  rate  is  the  direct  result  of  the  application  of  these  meas- 
ures ;  and  I  fully  believe  that  the  next  fifteen  years  will  see  a 
reduction  quite  equal  to  that  which  has  already  taken  place. 

If  we  accept  at  all  the  necessary  deductions  of  our  scientific 
convictions  in  relation  to  tuberculosis  there  can  be  no  escape 
from  the  conclusion  that  tuberculosis  is,  of  all  the  important  in- 
fectious diseases  with  which  we  have  to  deal,  certainly  the  most 
preventable.  The  experience  of  New  York  City  may  be  re- 
garded as  furnishing  proof  of  the  truth  of  this  conclusion 

Hermann  M.  Biggs. 


216 


II. -SUMMARY  OF  EXISTING  MEASURES  IN 

THE  PRINCIPAL   CITIES  OF  THE 

UNITED  STATES 

LILIAN  BRANDT 


SUAOIARY  OF  EXISTING  MEASURES  IN  THE  PRIN- 
CIPAL CITIES  OF  THE  UNITED  STATES 

To  ascertain  what  was  being  done  in  the  wa}^  of  administra- 
tive control  of  tuberculosis  in  the  principal  cities  of  the  country 
a  letter  of  inquiry  was  addressed  to  the  president  of  the  board  of 
health  in  each  of  the  seventy-eight  cities  of  more  than  50,000 
inhabitants.  After  a  suitable  interval  a  second  inquiry  was  sent 
to  all  who  had  not  responded  to  the  first.  From  ten  of  the 
cities  no  reply  whatever  was  elicited,  nor  were  the  letters  of 
inquiry  returned  unclaimed.  These  ten  were  Pittsburgh,  Alle- 
gheny, Harrisburgh  and  Scranton,  in  Pennsylvania ;  Charleston, 
South  Carolina ;  Des  ]\Ioines,  Iowa ;  Detroit,  Michigan ;  Kan- 
sas City,  Kansas;  Portland,  Maine;  and  St.  Joseph,  Missouri. 
The  infarmation  that  was  received  from  the  other  sixty-eight 
may  not  represent  quite  all  that  is  now^  being  done  by  the  city 
authorities,  as  new  measures  may,  in  a  few  cases,  have  been 
instituted  in  the  few  months  since  the  inquiry  was  made. 

In  fifty-nine  of  the  sixty-eight  cities  from  which  replies  were 
received  tuberculosis  is  now  "ofiQciallv  recognized  as  a  communi- 
cable disease,"  but  it  is  probably  true  that  "that  is  all  that  is 
done  in  the  matter,"  in  more  of  the  fifty-nine  than  the  one  which 
plaintively  admitted  that  such  was  the  state  of  afifairs.  On  the 
other  hand,  four  of  the  nine  cities  which  deny  that  they  recog- 
nize the  communicability  of  tuberculosis,  betray,  either  in  pub- 
lications of  the  department  or  in  answer  to  other  questions,  that 
they  efir'ectively  subscribe  to  the  doctrine. 

In  fifty-nine  of  the  sixty-eight  cities  also,  there  are  more  or 
less  comprehensive  ordinances  against  expectoration  in  public 
places,  and  in  two  or  three  others  an  ordinance  is  under  con- 
sideration. 

The  prohibition  contained  in  some  of  these  ordinances  ap- 
plies only  to  street  Cars,  the  enforcement  being  left  entirely  to 
the  street-car  companies  ;  in  others — a  few — practicallv  every 
public  spot  is  interdicted  to  the  promiscuous  spitter.  offenders 
are  subject  to  arrest,  and  as  severe  a  penalty  mav  be  imposed 
as  a  fine  of  $500  or  imprisonment  for  one  year.  In  four  of  the 
cities,  it  is  claimed,  the  ordinance  is  enforced  "strictly."  "suc- 
cessfullv,"  or  "well" ;  in  four  cities,  "fairly  well" ;  in  three, 
"never"  or  "not  at  all" ;    while  in  a  large  proportion  of  the  rest 

219 


ADMINISTRATlVi;    MEASURES 

the  enforcement  is  admittedly  "indifferent,"  "not  very  effective," 
"not  what  it  should  be,"  or  "not  rigid  enough,"  and  penalties 
are  imposed  only  "at  times"  or  "seldom."  It  is  sufficiently  evi- 
dent from  every-day  experience,  without  the  confirmation  of 
these  comments,  that  the  mere  existence  of  ordinances  against 
expectoration  does  not  solve  the  problem.  It  is  something, 
however,  that  in  so  many  cities  the  public  has  arrived  at  the 
point  of  realizing  that  the  ordinances  are  desirable,  and  doubt- 
less the  placards  which  are  displayed  have  some  psychological 
effect,  even  in  places  where  no  prosecutions  are  made.  The 
health  officer  of  one  city  remarked  that  "although  this  regulation 
is  not  enforced,  still  it  has  done  some  good." 

These  ordinances  are  all  of  recent  date.  Among  the  fifty- 
two  cities  which  furnished  information  on  this  point  of  date, 
New  York  was  the  pioneer,  early  in  1896,  closely  followed,  in 
the  same  year,  by  Boston  and  Los  Angeles.  In  1897  eleven 
other  cities  passed  similar  ordinances;  in  1898,  six;  in  1899, 
ten;  in  each  of  the  next  two  years,  eight;  but  since  1901  there 
have  been  only  six  added  to  the  list,  unless  some  of  the  seven 
which  failed  to  give  the  date  belong  here. 

The  reporting,  to  the  board  of  health,  of  all  cases  of  tuber- 
culosis, while  still  living,  is  requested  or  required  in  thirty-nine 
cities,  exactly  half  of  the  total  number  of  seventy-eight,  and  it  is 
contemplated  in  at  least  three  more.  Whether  this  notification 
is  "requested"  or  "required"  is  of  little  practical  significance, 
since  in  no  city  has  recourse  ever  been  had  to  prosecution  for 
failure  to  report,  even  if  such  failure  is  a  violation  of  a  "re- 
quirement" of  the  sanitary  code.  In  New  York  City  a  system 
of  persistently  reminding  institutions  and  physicians  of  their 
duties  in  this  respect  and  of  calling  them  to  task  for  every  de- 
linquency that  comes  to  the  knowledge  of  the  health  department, 
has  resulted  in  a  fairly  complete  registration.  Physicians  have 
repeatedly  been  summoned  to  appear  before  the  board  of  health 
to  explain  their  failure  to  report  cases.  When  they  have  failed 
to  appear  their  attendance  has  been  compelled  by  the  issuance 
of  a  subpoena.  Dr.  Biggs  estimates  that  the  department  has  a 
record  of  90  per  cent  of  the  consumptives  of  the  boroughs  of 
Manhattan  and  Bronx  before  their  death,  though  in  many  in- 
stances, of  course,  it  is  only  a  short  time  before  death.  In  a 
few  other  cities  some  such  devices  for  securing  the  co-operation 
of  physicians  have  been  tried,  but  in  none  with  sufficient  per- 
sistence to  bring  about  satisfactory  results.     Many  of  the  health 

220*^ 


ADMINISTKATIVIi    MKASUkES 

officers  of  the  cities  in  which  reports  are  required  commented 
that  the  regulation  is  "not  often  comphed  with"  or  "not  general- 
ly obeyed,"  or  volunteered  the  information  that  "very  few  re- 
ports are  received."  In  no  American  city,  so  far  as  is  known 
to  the  writer,  has  the  English  method  of  securing  registration 
been  adopted,  by  offering  a  small  fee,  usually  two  or  three  shill- 
ings, for  each  living  case  reported  by  a  physician.  If  neither 
inducements  nor  punishments  are  resorted  to,  in  order  to  secure 
compliance  with  a  requirement  to  report,  the  only  hope  seems  to 
lie  with  the  New  York  method  of  patient  persuasion  and  educa- 
tion, reenforced  by  the  threat  of  legal  procedure.  The  develop- 
ment of  this  necessary  part  of  a  system  of  administrative  control 
is,  as  would  be  expected,  even  later  and  less  far  advanced  than 
is  the  prohibition  of  spitting.  Most  of  the  progress  in  this 
direction  has  been  made  in  the  last  five  years. 

Disinfection  of  apartments  in  which  consumptives  have  lived 
is  recognized  to  be  desirable  in  sixty-one  of  the  sixty-eight  cities 
from  which  replies  were  received.  In  two,  however,  it  is  "not 
done,  on  account  of  lack  of  appropriations" ;  in  three,  "not 
unless  requested"  ;  in  twenty-seven  it  is  done  only  "on  request" ; 
in  three  others,  "sometimes"  or  "occasionally" ;  in  two  it  is 
"recommended" ;  and  in  regard  to  fourteen  the  extent  to  which 
it  is  done  is  not  specified.  In  the  other  ten  cities,  it  is  claimed, 
disinfection  is  "required"  after  the  death  or  removal  of  a  con- 
sumptive. The  favorite  method  of  disinfection  is  by  formalde- 
hyde ;  but  in  eight  cases  the  scrubbing  of  floors  and  woodwork 
is  added,  and  the  disinfection  of  bedding  and  clothing  by  steam, 

Something  in  the  way  of  educational  work  is  attempted  by 
the  health  department  in  twenty-nine  of  these  cities.  The  usual 
method  is  to  distribute,  more  or  less  widely,  circulars  of  informa- 
tion in  regard  to  the  nature  of  consumption,  how  to  avoid  con- 
tracting it  or  giving  it  to  others,  and  how  the  consumptive  should 
live.  In  a  very  few  instances  use  is  made  of  the  daily  press, 
and  public  lectures  are  given. 

New  York  seems  to  be  the  only  city,  so  far,  in  which  nurses 
are  employed  by  the  department  for  the  express  purpose  of 
visiting  poor  consumptives  in  their  homes.  In  Rochester  one 
has  been  asked  for ;  in  Peoria  one  nurse,  employed  by  the  board 
of  health,  is  sent  to  tuberculosis  cases  as  well  as  to  others ;  in 
Cleveland,  Washington,  and  Syracuse,  by  co-operation  with 
private  organizations,  nurses  are  available  for  the  needs  of  the 
department. 

221 


ADMINISTRATIVE    MEASURES 

In  at  least  fifteen  of  the  cities  sputum  is  examined  for  physi- 
cians free  of  charge.  The  milk  and  meat  supply  is  under  more 
or  less  rigid  control,  either  by  city  authorities  or  the  state  board 
of  health,  in  sixty-two  of  the  cities.  In  only  a  few  cases  is 
there  careful  inspection  of  the  cattle,  particularly  in  dairies,  for 
tuberculosis.  Any  supervision,  however,  which  has  the  effect 
of  raising  the  standard  of  milk  or  meat  supplied  to  the  market, 
is  an  indirect  measure  for  lessening  tuberculosis. 

Several  miscellaneous  measures  that  have  been  adopted  in 
different  places  deserve  mention.  A  few  cities  supply  sputum 
cups  free  of  charge  to  needy  consumptives.  In  Bridgeport, 
Connecticut,  tuberculous  children  and  pupils  are  excluded  from 
the  public  schools.  Indiana  has  recently  passed  a  state  law  to 
the  same  effect.  This  seems,  on  the  whole,  neither  necessary 
nor  desirable.  Cincinnati  has,  a  few  months  since,  put  in  force 
a  well-planned  system  for  the  control  of  tuberculosis  which  has 
at  least  one  distinctive  feature.  A  physician  who  is  specially 
qualified  to  do  the  work  is  employed  to  hold  office  hours  at 
the  department,  for  the  purpose  of  making  physical  examination 
of  suspected  cases,  on  any  physician's  request.  By  this  means 
it  is  hoped  that  many  cases  will  be  caught  in  the  very  early 
stages,  before  the  sputum  contains  bacilli,  or  even  before  there  is 
any  expectoration.  The  more  important  measures  which  are  pecu- 
liar to  New  York,  among  American  cities,  are,  in  addition  to 
the  provision  for  visits  in  the  home,  by  nurses  and  physicians, 
the  establishment  and  maintenance  of  a  free  municipal  clinic 
especiallv  for  the  treatment  of  tuberculosis  and  the  exercise  of 
the  right  of  forcible  removal. 

In  view  of  the  fact  that  we  have  for  twenty-two  years  had 
in  our  possession  all  the  knowledge  essential  to  the  intelligent 
sanitary  surveillance  of  this  disease,  it  seems  incredible  that  so 
little  has  been  done.  The  situation  is  a  reproach  to  our  intelli- 
gence and  our  public  spirit,  a  reproach  which  will  only  be  re- 
moved when  every  city  in  the  land  will  have  put  into  force,  in  its 
main  features  and  wath  whatever  modifications  are  necessary  for 
local  conditions,  the  system  of  administrative  control  outlined 
by  Dr.  Biggs  in  the  preceding  pages.  It  is  encouraging  that 
thirty  of  the  seventy-eight  cities  reported  that  plans  were  under 
consideration  for  the  introduction  of  essential  measures  or  for 
the  further  development  of  a  system  alreadv  existing. 

Lilian  Brandt. 

222 


Part  VI 

ASSOCIATIONS    FOR  THE  PREVENTION    OF 

TUBERCULOSIS:  SOCIETIES,  COMMITTEES, 

STATE  COMMISSIONS 


I.— ORGANIZATION    AND    FUNCTION    OF    A 

SOCIETY  FOR  THE  PREVENTION    OF 

TUBERCULOSIS 

EDWARD  T.    DEVINE 

■GENERAL  SECRETARY    OF  THE  CHARITY  ORGANIZATION  SOCIETY  OF 
THE  CITY  OF  NEW  YORK 


THE  ORGAXIZATIOX  AND  FUNCTION  OF  A 

SOCIETY  FOR  THE  PREA^ENTION  OF 

TUBERCULOSIS 

There  is  no  city  in  the  United  States  in  which  a  society  for 
the  prevention  of  tuberculosis  would  be  useless  or  out  of  place. 
In  no  two,  probably,  would  the  activities  of  such  a  society  be 
just  alike,  but  in  every  one  there  exists  the  need  for  organized 
effort  in  reducing  to  a  minimum  the  distress  and  loss  of  life 
caused  by  this  preventable  disease. 

The  need  for  such  effort  is  more  conspicuous  in  the  large 
cities,  but  the  chance  for  satisfactorv  results  is  greater  in  the 
town  of  a  few  thousand  inhabitants.  In  the  small  town  it  should 
be  possible  to  give  proper  care  to  every  consumptive,  to  control 
every  center  of  infection,  to  inform  the  public  mind  thoroughly, 
and  to  keep  up  with  the  needs  of  the  population  as  it  increases. 
These  needs  would  be  chiefly  in  the  way  of  education,  inasmuch 
as  the  original  provision  for  the  sick  would,  if  the  society  worked 
eft'ectively,  continue  to  be  adequate  and  ultimately  become  mi- 
necessary.  In  a  large  city,  on  the  other  hand,  the  great  numbers 
of  sick  requiring  hospital  and  sanatorium  care,  the  far  greater 
numbers  of  persons  to  be  instructed,  and  the  greater  difficultv  in 
securing  for  all  wholesome  conditions  of  living,  make  the  task 
seem  less  hopeful  at  the  same  time  that  they  emphasize  the  im- 
portance of  undertaking  it.  Fortunately,  in  a  large  citv  many 
agencies  will  be  found  already  working  indirectly  for  the  solu- 
tion of  the  tuberculosis  problem,  and  ready  to  undertake  various 
parts  of  the  task.  But  however  efficient  the  health  department, 
however  plentiful  the  hospitals,  there  will  always  remain  the 
Avork  of  education. 

■  In  regard  to  the  composition  of  such  an  association  the  same 
general  rule  will  apply  everywhere.  x\  membership  that  is  rep- 
resentative, not  only  of  the  medical  profession,  but  of  other 
interests  and  activities,  and  especially  of  existing  agencies  con- 
cerned with  the  public  health  and  practical  philanthropy  is  an 
initial  advantage  in  enlisting  the  co-operation  of  all  the  forces 
in  the  community  and  the  interest  of  all  classes,  and  is  a  con- 
stant safeguard  against  partisan  views. 

225 


SOCIETIES  AND   COMMITTEES 

Whether  the  association  shall  be  independent  or  under  the 
auspices  of  some  existing  organization  is  a  question  to  be  de- 
termined by  local  conditions.  Both  methods  have  been  tried 
with  satisfactory  results.  In  New  York,  for  instance,  the  associ- 
ation formed  for  this  specific  purpose  is  a  committee  of  the 
Charity  Organization  Society,  in  Chicago  it  is  affiliated  with 
the  Visiting  Nurse  Association ;  in  Saint  Louis,  it  is  a  commit- 
tee of  the  Civic  Improvement  League;  while  on  the  other  hand 
the  Boston  and  Scranton  societies  are  examples  of  independent 
organizations.  If  the  opportunity  presents  itself  of  affiliation 
with  an  organization  of  generally  recognized  importance  in 
social  work,  it  may  be  desirable  for  the  new  association  to  enter 
public  life  sO'  sponsored,  assuming  that  there  are  no  conditions 
which  might  hamper  its  development  in  the  future.  On  the 
other  hand,  the  purpose  of  the  new  enterprise  should  be  sufficient 
to  commend  itself  to  the  public,  provided  that  the  personnel  is 
guarantee  that  the  work,  as  undertaken,  will  be  worth  while. 

The  work  which  should  be  undertaken  is  also  determined 
largely  by  local  conditions.  The  general  features  of  a  compre- 
hensive campaign  being  agreed  upon,  it  is  the  part  of  the  society 
or  committee  for  the  prevention  of  tuberculosis  to  initiate  those 
parts  of  the  task  which  have  not  been  undertaken  by  any  exist- 
ing agency.  A  thorough  survey  of  the  situation  should  be  pre- 
liminary to  any  plan  of  action.  Care  should  then  be  had  not  to 
duplicate  any  work  already  being  well  done  by  the  department 
of  health  or  by  a  private  society,  though  all  possible  assistance 
and  encouragement  should  be  given  to  such  work.  In  develop- 
ing the  campaign  it  will  often  be  found  possible  to  induce  older 
organizations  to  undertake  such  parts  of  it  as  are  especially  ap- 
propriate to  them.  Certain  essential  measures,  such  as  the  con- 
trol of  indiscriminate  expectoration,  the  registration  of  liv- 
ing cases,  disinfection,  and  free  bacteriological  examination  of 
sputum,  are  more  properly  governmental  functions  and  can  best 
be  administered  by  an  efficient  board  of  health.  In  a  com- 
munity which  has  a  department  of  health  no  efforts  should  be 
spared  to  secure  the  expansion  of  its  activities  until  it  has  de- 
veloped the  system  of  control  described  in  this  volume.  In  a 
community  without  an  efficient  department  of  health  the  society 
will  find  itself  forced  to  try  to  supply  the  lack,  preferably  by 
securing  the  efficient  department. 

The  hospital  and  sanatorium  question  will,  it  is  safe  to  pre- 

226 


SOCIETIES  AXD  COMMITTEES 

diet,  be  of  pressing  importance  for  some  time  to  come  in  every 
city.  Xot  until  there  is  sufficient  accommodation  for  every  con- 
sumptive who  cannot  receive  proper  treatment  at  home  can  it 
be  disregarded.  There  is  room  here  for  state,  municipal  and 
private  enterprise,  and  little  danger  that  the  provision  by  all  of 
them  combined  will  exceed  the  demand.  Although  sanatorium 
treatment  is  preferable  for  most  patients,  even  those  in  the  earliest 
stages  of  the  disease,  nevertheless  the  special  dispensary  is  now, 
and  will  for  some  time  continue  to  be,  a  most  important  element 
in  the  provision  for  the  tuberculous  poor.  For  ambulant  cases 
who  are  obliged  to  go  on  working,  or  for  whom  there  is  no 
room  in  a  sanatorium,  the  special  dispensary,  with  its  visit- 
ing nurses,  is  at  least  the  best  makeshift  yet  devised  for  sana- 
torium treatment,  and  on  the  educational  side  it  has  large 
possibilities.  Charitable  assistance  is  required  sooner  or  later 
by  many  families  in  which  a  case  of  tuberculosis  occurs.  It  is 
not  always  necessary,  perhaps  it  is  not  generally  desirable,  that 
the  society  for  the  prevention  of  tuberculosis  should  attempt 
to  supply  material  relief;  but  it  should  at  least  establish  rela- 
tions with  existing  relief  agencies  and  supplement  their  efforts 
in  any  way  that  is  required,  and  it  should  keep  constantly  in 
mind  and  before  the  public  the  fact  that  the  care  of  consumptives 
in  their  homes  is  a  most  important  part  of  any  scheme  for  the 
eradication  of  this  disease. 

There  is  practically  no  limit  to  the  amount  of  educational 
work  to  be  done  by  one  of  the  societies  under  discussion.  By 
lectures  to  all  classes  of  society,  by  distribution  of  literature,  by 
house-to-house  visits,  by  newspaper  articles,  by  co-operation 
with  the  public-school  teachers  and  trade  unions,  and  in  many 
other  ways,  the  work  of  informing  the  public  in  regard  to  the 
nature  of  tuberculosis  and  the  way  to  avoid  it  and  to  prevent  its 
spread  can  be  carried  on.  Xor  is  this  work  completed  so  long 
as  any  members  of  the  community  remain  uninformed. 

The  care  of  the  tuberculous  inmates  of  any  insane  hospitals 
or  penal  or  charitable  institutions  within  the  territorial  bounds 
set  by  the  society  should  be  a  matter  of  interest  to  the  society, 
and  all  possible  eft'orts  should  be  made  to  bring  about  the  intro- 
duction of  proper  treatment  in  such  institutions. 

In  addition  to  all  the  direct  methods  of  attacking  tuberculosis 
there  are  many  indirect  methods  which  are  no  less  important 
and  which,  in  fact,  are  essential  to  a  successful  crusade  against 

227 


SOCIETIES  AND   COMMITTEES 

this  disease.  It  is  quite  within  the  province  of  a  society  for  the 
prevention  of  tuberculosis  to  initiate  a  movement  for  improved 
housing  conditions  or  for  better  sanitary  conditions  in  factories, 
workshops,  stores,  and  schools,  or  for  playgrounds  in  the  crowd- 
ed districts  of  the  city.  In  a  community  in  which  there  is  no 
other  active  and  aggressive  body  to  do  such  work  it  even  be- 
comes a  duty.  In  any  case  every  movement  which  has  for  its 
object  the  improvement  of  living  or  working  conditions  should 
be  heartily  supported. 

Edward  T.  Devine. 


228 


II.— ASSOCIATIONS    FOR  THE   PREVENTION 

OF  TUBERCULOSIS  IN  THE  UNITED 

STATES  AND  CANADA 

Arranged  in  alphabetical  order,  according  to  states 


NATIONAL  ASSOCIATION 


The;  National  Associa.tion  for  the;  Study  and  Prevention 
oE  Tuberculosis  (June  6,  1904)  : 
Objects : 

1.  The  study  of  tuberculosis  in  all  its  forms  and  relations. 

2.  The  dissemination  of  knowledge  concerning  the  causes, 
treatment,  and  prevention  of  tuberculosis. 

3.  The   encouragement  of   the  prevention   and   scientific 
treatment  of  tuberculosis. 

After  preliminary  meetings  in  Baltimore  and  Philadelphia 
the  constitution  and  by-laws  of  the  national  association  were 
finally  adopted  on  Monday,  June  6,  at  Atlantic  City,  and  officers 
were  chosen. 

Dr.  Edward  L.  Trudeau,  of  Saranac  Take,  N.  Y.,  is  the 
first  president;  Dr.  William  Osier,  of  Baltimore,  and  Dr.  Her- 
mann M.  Biggs,  of  New  York,  are  vice-presidents ;  Dr.  George 
M.  Sternberg,  of  Washington,  D.  C,  late  Surgeon-General,  is 
treasurer ;  and  the  secretary  is  Dr.  Henry  Barton  Jacobs,  of 
Baltimore.  The  board  of  directors,  including  the  officers  above 
named,  consists  of  Drs.  Norman  Bridge,  of  California;  S.  E. 
Solly,  of  Colorado ;  John  P.  C.  Foster,  of  Connecticut ;  George 
M.  Sternberg,  of  Washington,  D.  C. ;  Arnold  C.  Klebs  and 
Robert  H.  Babcock,  of  Illinois ;  John  N.  Hurty,  of  Indiana ; 
William  H.  Welch,  William  Osier,  Henry  Barton  Jacobs,  and 
John  S.  Fulton,  of  Maryland ;  Henry  M.  Bracken,  of  Minne- 
sota ;  William  Porter,  of  Missouri ;  Edward  O.  Otis  and  Vin- 
cent Y.  Bowditch,  of  Massachusetts ;  Victor  C.  Vaughan,  of 
Michigan;  Mr.  Frederick  L.  Hoffman,  of  New  Jersey;  Drs. 
Hermann  M.  Biggs,  S.  A.  Knopf,  and  Edward  L.  Trudeau  and 
Mr.  Edward  T.  Devine,  of  New  York ;  Drs.  Charles  L.  Minor,  of 
North  Carolina ;  Charles  O.  Probst,  of  Ohio;  Lawrence  F. 
Flick,  Mazyck  P.  Ravenel, Howard  S.  Anders  and  Leonard  Pear- 
son, of  Pennsylvania;  Matthew  M.  Smith,  of  Texas;  Major 
George  E.  Bushnell,  of  the  United  States  Army  Hospital,  Fort 
Bayard ;  and  Surgeon-General  Walter  Wyman,  of  the  United 
States  Marine  Hospital. 

Its  membership  is  to  consist  of  three  classes : 

I.  Members — Those  who  are  elected  by  the  board  of  direc- 
tors and  who  pay  annual  membership  dues  of  $5.     2.  Life  mem- 

231 


CALIFORNIA 

bers — Those  who  pay  $200  and  are  ah'eady  members  of  the 
Association.  3.  Honorary  members — Persons  distinguished  for 
original  researches  relating  to  tuberculosis,  or  eminent  as  sanitari- 
ans or  as  philanthropists,  who  have  given  material  aid  in  the 
study  and  prevention  of  tuberculosis.  The  list  of  members  al- 
ready numbers  two  hundred  and  fifty  names,  including  the  lead- 
ing workers  in  the  subject  of  tuberculosis,  both  lay  and  profes- 
sional, throughout  the  country.  A  fund  is  being  accumulated 
to  insure  its  financial  success. 

The  government  of  the  Association,  the  planning  of  work, 
the  arrangements  for  meetings  and  congresses,  and  everything 
that  appertains  to  legislation  and  direction,  is  in  the  hands  of 
the  board  of  directors,  and  committees  have  the  power  to 
execute  only  what  is  directed  by  the  board. 

The  board  of  directors  is  empowered,  however,  to  appoint 
an  executive  committee  of  seven  members,  of  which  the  presi- 
dent and  secretary  of  the  Association  shall  be  ex-ofUcio  mem- 
bers, to  which  is  entrusted  the  executive  work  of  the  Associa- 
tion. This  committee,  chosen  at  the  meeting  in  Atlantic  City, 
consists  of  Dr.  Edward  L.  Trudeau,  Dr.  Henry  Barton  Jacobs, 
Dr.  William  Osier,  Dr.  Hermann  M.  Biggs,  Dr.  Edward  O. 
Otis,  Dr.  Mazyck  P.  Ravenel,  Dr.  Arnold  C.  Klebs,  Dr.  John 
N.  Hurty,  and  Mr.  Edward  T.  Devine. 

A  fund  is  being  accumulated  to  insure  the  financial  success 
of  the  Association. 

Communications  should  be  addressed  to  the  Secretary, 
United  Charities  Building,  105  East  22d  Street,  New  York  City. 

CALIFORNIA 

The     Southern     Caijeornia    Anti-Tubercueosis    League 
(June,  1903)  : 

Objects :  "To  combat  the  spread  of  tuberculosis  by — 
"i.  Research. 
"2.  Education. 
"3.  Practical  work  in  the  relief  and  cure  of  indigent 

patients  afflicted  wth  tuberculosis. 
"4.  Co-operation  with  organizations  of  similar  aim." 

Several  pub-Hc  meetings  have  been  held,  at  which  talks  have 
been  given  on  the  prevention  of  tuberculosis.  Short  articles 
have  been  placed  in  daily  papers.  A  pamphlet  has  been  pre- 
pared on  "Things  the  Laity  should  know  about  Consumption." 

232 


CALIFORNIA 

and  a  circular  of  "Precautionary  Suggestions  for  the  Afflicted/' 
Arrangements  have  been  made  for  the  distribution  of  eighty- 
nine  thousand  of  these  over  Southern  Cahfornia,  through  the 
schools  and  in  other  ways.  A  lecture  bureau  is  maintained 
which  agrees  to  furnish  lecturers  to  all  organizations  that  may 
apply.  It  is  planned  to  continue  and  extend  the  work  through 
the  press. 

Communications  should  be  addressed  to  either  F.  M.  Pot- 
tenger,  M.  D.,  President,  Monrovia,  California,  or  Rose  T. 
Bullard,  M.  D.,  Secretary,  Bradbury  Building,  Los  Angeles. 

The  Tuberculosis  Committee  of  the  Medical  Society  of 
THE  State  of  California  (April,  1903)  : 

Objects:  To  collect  data  bearing  upon  the  tuberculosis 
problem  as  it  exists  in  the  state  of  California  and  to 
make  recommendations  to  the  next  annual  meeting  of 
the  Society. 

Inquiries  were  sent  to  everv  physician  and  officer  of  health 
in  the  state  and  on  the  answers  received  the  Committee  based 
its  report.  The  report  embodied  a  recommendation  to  physi- 
cians that  they  should  "educate  their  patients  as  to  the  nature  of 
the  disease  and  the  manner  of  its  prevention" ;  the  work  done 
by  organizations  attempting  to  combat  the  disease  was  endorsed ; 
and  the  Committee  declared  itself  opposed  to  "all  forms  of 
phthisiophobia"  and  to  "unscientific,  unpractical  and  inhumane"" 
legislation,  but  heartily  in  favor  of  the  rigid  enforcement  of  anti- 
expectoration  ordinances,  the  provision  of  cuspidors  in  public 
places,  compulsory  notification,  for  the  purpose  of  instruction 
and  disinfection,  and  state  sanatoriums  for  the  poor. 

A  final   recommendation  was  made  to  the  effect  "that  the 

work  of  the  Committee  be  continued  for  the  following  purposes : 

"(a)   To  keep  in  touch  with  similar  work  done  in  other 

localities. 
''(b)   To  institute  educational  measures. 
"(c)    To  secure  the  adoption  of  anti-expectoration  laws, 
"(rf)    To  devise  ways  and  means   for  securing  the  dis- 
infection of  public  vehicles  used  for  the  trans- 
portation  of  consumptives, 
"(-c)   To   present  to  the  governor  and   state  legislature 
the  matter  of  the  importance  and  necessity  of 
state  sanatoriums  for  the  treatment  of  the  poor.'" 
233 


CONNECTICUT,   DISTRICT  OI?   COIvUMBIA 

Communications  should  be  addressed  to  either  Dr.  F.  M. 
Pottenger,  Chairman,  Monrovia,  or  Dr.  Edward  von  Adelung, 
Secretary,  Oakland. 

CONNECTICUT 

The:  New  Haven  County  Anti-Tubercueosis  Association 

(1903): 

Thus  far  this  Association  has  concentrated  its  efforts  on  the 
erection  of  the  Gay  lord  Farm  Sanatorium  (see  page  41). 

Communications  should  be  addressed  to  Dr.  John  P.  C.  Fos- 
ter, Chairman  of  the  Executive  Committee,  109  College  Street, 
New  Haven. 

DISTRICT  OF  COLUMBIA 

The  Associated  Charities'  Committee  on  the  Prevention 
OF  Tuberculosis  (December,  1902)  : 

Objects :  "To  combat  the  spread  of  tuberculosis,  to  bet- 
ter the  condition  of  patients  suffering  from  it,  and  to 
promote  their  recovery." 

Since  its  organization  the  Committee  has 

1.  Assisted  in  securing  the  passage  of  an  anti-expectoration 
law. 

2.  Arranged  lectures  by  prominent  physicians  and  laymen, 
in  churches,  before  Citizen  Associations,  etc.,  reaching  from  100 
to  2,500  people  each  week. 

3.  Prepared  about  one  hundred  special  stereopticon  views 
for  use  in  illustrating  these  lectures. 

4.  Established  a  free  loan  library  for  instruction  regarding 
consumption. 

5.  Proposed  laws  for  registration  of  all  consumptives  and 
free  examination  of  sputum  by  health  department. 

6.  Arranged  for  distribution  of  literature  through  public 
school  pupils. 

7.  Secured  money  from  private  contributors  for  the  erection 
of  four  tent  pavilions  for  the  treatment  of  consumptives.  These 
are  attached  to  the  overcrowded  Almshouse  Hospital — the  only 
hospital  in  Washington  which  receives  consumptives. 

8.  Opened  a  dispensary  for  the  free  examination  and  treat- 
ment of  those  who  are  suffering  from  tuberculosis  (see  page 
167). 

The  plans  for  the  future  are  to  continue  agitation  and  efforts 
along  the  same  lines  and  to  aid  in  securing  the  erection  of  a 

234 


GEORGIA,   ILLINOIS 

municipal  hospital   for  consumptives.     The  estabhshment  of  a 
hospital-camp  is  under  discussion. 

Communications  should  be  addressed  to  Charles  F.  Weller, 
Secretary.  8ii  G  Street,  N.  W. 

GEORGIA 

A  State;  Commission  was  appointed  by  the  governor  in 
August,  1904,  to  "investigate  the  extent  of  tuberculosis  in  Geor- 
gia and  means  of  stamping  out  the  disease."  This  Commission 
consists  of  one  physician  from  each  congressional  district  and 
ten  from  the  state  at  large.  It  will  co-operate  with  the  state 
board  of  health  and  also  with  the  recently  organized  committee 
on  tuberculosis  of  the  State  IMedical  Association.  Its  first 
meeting  was  held  in  Macon  on  October  19. 

The  Chairman  of  the  State  Commission  is  Dr.  Charles  Hicks, 
of  Dublin. 

Thk  State;  Medical  x\ssociation  has  recently  appointed  a 
Committee  on  the  Prevention  of  Tuberculosis  of  its  own  mem- 
bers. Literature  will  be  distributed  and  a  tuberculosis  exhibit  is 
planned  in  connection  with  the  next  annual  meeting  of  the  Asso- 
ciation in  April,  1905. 

The  Secretary  of  this  Committee  is  ]\I.  A.  Clark,  M.  D., 
]\lacon,  Georgia. 

ILLINOIS 

Committee  on  the  Prevention  of  Tuberculosis  of  the  Vis- 
iting Nurse  Association  of  Chicago  (January,  1903)  : 

Objects:  To  collect  and  file  all  information  regarding 
tuberculosis  in  Chicago. 

To  educate  individuals  and  the  public  at  large  about 
tuberculosis  and  its  prevention  by  lectures,  printed  mat- 
ter, press  articles,  and  through  assistants. 

To  attend  to  all  tuberculosis  cases  applying  for  help  or 
treatment  at  the  district  ofiices  or  in  their  homes,  pro- 
viding medical,  nursing,  and,  to  a  very  limited  extent, 
material  aid. 

A  Central  Office  is  maintained  at  1414  Unity  Building,  as  an 
executive  centre,  library  and  record  room. 

Here  a  double  card  catalogue  of  all  cases  is  kept.  The  first, 
filed  alphabetically  under  the  patient's   name,  gives   the   social 

235 


ILIvINOIS 

and  house  information  in  regard  to  cases  under  the  care  of  the 
visiting  nurse,  the  dispensary  physicians,  and  other  interested 
physicians.  The  second  is  a  house  catalogue,  covering  every 
street  in  the  city,  in  which  may  be  found  the  cases  reported  each 
week  from  the  Health  Department,  the  County  Hospital  and 
free  dispensaries,  as  well  as  the  Cook  County  Hospital  for  Con- 
sumptives. Maps  and  charts  are  on  file,  giving  population,  over- 
crowding and  in  certain  wards  the  location  of  cases  of  tuber- 
culosis. 

A  bibliography  of  current  literature  is  kept  up  and  twenty- 
seven  journals  relating  to  tuberculosis,  public  health,  and  hy- 
giene, are  on  file. 

Sputum  is  examined  for  the  dispensaries  through  the  gen- 
erosity of  the  Columbus  Medical  Laboratory.  Application  for 
disinfection  is  made  to  the  Health  Department,  and  for  removal 
of  cases  to  the  County  Agent. 

Lectures  are  given  to  various  organizations  in  all  parts  of 
the  city.  The  printed  matter  issued  thus  far  consists  of  a  Pre- 
liminary Report ;  a  reprint  of  the  set  of  articles  published  in 
the  Revieiv  of  Reviezvs  for  June,  1903,  under  the  title,  "New 
Hope  for  Consumptives" ;  directions  to  district  physicians  and 
nurses ;  and  a  paper  on  "Tuberculosis  in  the  Jewish  District  of 
Chicago,"  by  Dr.  T.  B.  Sachs. 

It  is  planned  to  distribute  leaflets  to  patients,  to  placard 
lodging  houses,  to  increase  the  efficiency  of  the  dispensaries 
(see  page  155),  to  open  sanatoriums,  and  to  secure  an  endow- 
ment fund  for  the  support  of  these  projects. 

Communications  should  be  addressed  to  Dr.  Wm.  A.  Evans, 
Secretary,   1414  Unity  Building,  79  Dearborn   Street,  Chicago. 

Committee  on  Tuberculosis  oe  the  Ielinois  State  Medical 
Society  (May,  1904)  : 

Object:  To  secure  an  appropriation  from  the  legislature 
for  the  establishment  of  a  state  sanatorium  for  the 
care  and  cure  of  those  suffering  from  tuberculosis. 

This  committee  was  appointed  at  the  1904  meeting  of  the 
State  Medical  Society.  Work  was  begun  promptlv  by  the  dis- 
tribution of  a  circular  on  the  nature  ol  tuberculosis,  which  was 
largely  quoted  in  the  press  of  the  state.  As  part  of  the  pro- 
gram of  educating  the  public  mind  to  the  point  of  establishing  a 

236 


INDIANA,    MARYLAND 

state   sanatorium,   a   tent   colony   has   been    started   at    Ottawa. 
(For  description  see  page  45.) 

It  is  hoped  that  this  project  will  prove  to  many  who  could 
not  otherwise  be  convinced  the  correctness  of  the  position  that 
consumption  can  be  cured  as  easily  in  Illinois  as  anywhere  else. 
The  support  of  eight  hundred  newspapers  throughout  the  state, 
is  assured  the  Committee  in  its  efforts  for  securing  a  state 
sanatorium. 

Communications  should  be  addressed  to  Dr.  J.  W.  Pettit, 
Secretary,  Ottawa,  111. 

INDIANA 

The  Anti-Tuberculosis  Society  oe  Indiana  (October,  1904)  : 
At  the  close  of  a  public  lecture  by  Dr.  S.  A.  Knopf  this 
society  was  organized,  with  the  primary  object  of  securing  the 
establishment  of  a  state  institution  for  the  treatment  of  early 
cases  of  tuberculosis. 

Communications  should  be  addressed  to  Dr.  Theodore  Pot- 
ter, Secretary  and  Treasurer. 

MARYLAND 

The  Tuberculosis  Commission  oe  Maryland.     (Appointed 
by  act  of  the  legislature,  April  8,  1902)  : 

Object:  "To  investigate  the  prevalence,  distribution  and 
causes  of  human  tuberculosis  in  the  state  of  Mary- 
land, to  determine  its  relations  to  the  public  health  and 
welfare,  and  to  devise  ways  and  means  of  restricting 
and  controlling  said  disease." 

In  accordance  with  these  instructions  the  Commission  has 
imdertaken  a  census  of  the  tuberculous  casts  in  Baltimore  and 
the  state  at  large;  it  has  made  a  special  study  of  the  cost 
entailed  by  the  disease  in  each  case,  on  the  individual,  his  family 
and  the  state,  as  well  as  of  the  influence  of  habits,  occvipation 
and  housing  conditions.  A  full  account  of  the  results  of  these 
investigations  and  legislative  enactments  relating  to  tuberculosis 
is  contained  in  the  recently  published  report  to  the  governor 
of  the  state. 

A  Tuberculosis  Exposition  was  held  in  Baltimore  the  week 
beginning  January  25,  1904,  under  the  joint  auspices  of  the 
Commission  and  the  Maryland  Public  Health  Association.  Mc- 
Coy Hall,  at  Johns  Hopkins  University,  was  converted  into  a 

237 


MARYLAND,   MASSACHUSETTS 

museum,  where,  by  charts,  architects'  plans,  photographs,  Htera- 
ture,  models  and  other  devices,  the  various  kinds  of  anti-tuber- 
culosis work  in  progress  throughout  the  United  States  were 
displayed.  Lectures  on  important  phases  of  the  subject  were 
delivered  by  leading  specialists.  The  hall  was  crowded  with 
an  enthusiastic  audience  at  every  lecture.  Eminent  physicians 
and  sanitarians  were  in  attendance  from  the  principal  cities  of 
the  United  States  and  Canada,  and  it  is  probable  that  the  total 
number  of  visitors  during  the  week  amounted  to  five  thousand. 

The  Commission  goes  out  of  ofhce  by  the  expiration  of  the 
terms  of  its  members  in  the  fall  of  1904.  A  new  Commission 
was  appointed  by  the  governor  in  June,  1904,  for  a  term  of  two 
years. 

Communications  should  be  addressed  to  Marshall  Langton 
Price,  M.  D.,  Medical  Officer,  Charles  Street  and  North  Ave- 
nue, Baltimore. 

MASSACHUSETTS 

The  Boston  Association  for  the  ReeiEE  and  Controe  oe 
Tuberculosis  (1903)  : 

Objects :  To  promote  a  careful  study  of  conditions  re- 
garding tuberculosis  in  Boston ;  to  educate  public  opin- 
ion as  to  the  causes  and  prevention  of  tuberculosis ;  and 
to  arouse  general  interest  in  securing  adequate  pro- 
vision for  the  proper  care  of  tuberculous  patients  in 
their  homes  and  by  means  of  hospitals  and  sanatoriums. 

In  the  period  since  its  organization,  over  a  year  ago,  the 
activities  of  the  Association  have  included  : 

1.  The  collection  of  information  in  regard  to  more  than 
4,500  consumptives. 

2.  The  distribution  of  70,000  copies  of  a  four-page  leaflet 
called  "A  War  upon  Consumption,"  in  the  schools,  at  lectures, 
and  elsewhere. 

3.  The  arranging  of  about  80  lectures  in  different  parts  of 
the  city — several   in   schools — to  teachers,  pupils,  and  parents. 

4.  The  sending  of  45  patients  to  the  State  Sanatorium,  or 
other  institutions,  or  the  country,  and  the  caring  for  others  at 
home. 

5.  The  rousing  of  interest  in  a  project  for  a  private  hospital 
for  advanced  cases  and  a  day  sanatorium. 

6.  The  beginning  of  an  agitation  for  a  municipal  hospital. 

238   • 


MASSACHUSETTS 

/.  Co-operation  with  trades  unions,  by  supplying  lecturers 
and  literature  on  this  subject. 

8.  An  exposition  somewhat  similar  to  that  in  Baltimore. 

In  addition  to  a  continuation  of  its  work  in  these  directions 
the  plans  for  the  future  include : 

1.  A  study  of  relations  between  tuberculosis  and  housing 
conditions,  occupations,  habits  and  diet. 

2.  Lectures,  particularly  to  teachers,  clergy,  and  others  who 
will  repeat  what  they  hear.  Distribution  of  pamphlets,  and  of  a 
wall-card  for  shops  telling  the  results  of  spitting  in  improper 
places.     Agitation  against  such  spitting. 

3.  Extended  co-operation  with  the  Board  of  Health  in  the 
removal  of  patients  most  likelv  to  spread  consumption.  Par- 
ticular attention  to  patients  discharged  from  the  Sanatorium. 

4.  An  extension  of  the  work  among  the  trades  unions. 
Communications  should  be  addressed  to  Alexander  M.  Wil- 
son, General  Secretary,  8  Beacon  Street,  Boston. 

Tuberculosis  Aid  and  Education  Association  oe  Cambridge 
(1903): 

Objects:  To  cure,  at  home  if  possible,  persons  suffering 
with  tuberculosis;  to  relieve  with  food,  as  far  as  possi- 
ble, all  needy  tuberculous  persons ;  to  educate  the 
entire  community  in  the  prevention  and  cure  of  this 
disease ;  to  promote  the  establishment  of  hospitals  for 
hopeless  cases. 

Under  the  auspices  of  the  Association  a  public  lecture  has 
been  given,  at  which  the  attendance  was  400.  Copies  of  papers 
v/ritten  by  medical  experts  and  pamphlets  descriptive  of  sana- 
toriums  have  been  placed  in  the  Public  Library.  Necessary  diet 
and  nursing  are  provided  for  needy  cases  reported  by  physicians. 

The  plans  for  the  future  include 

(i)   A  continuation  of  the  home  care. 

(2)  Classes  in  medical  gymnastics,  under  the  direction  of 
a  physician. 

(3)  Lectures  and  the  wide  circulation  of  pamphlets  in 
regard  to  proper  nutrition,  the  value  of  sunshine  and  fresh  air, 
exercise,  and  other  subjects  allied  to  the  general  one  of  health- 
ful living. 

Communications  should  be  addressed  to  Miss  Eda  A.  Wool- 
son,  Secretary,  277  Harvard  Street,  Cambridge. 

239 


massachusetts,  minnesota 

The  Springfield  Association  eor  the  Prevention  of 
Tuberculosis  was  organized  on  November  21,  1904,  with 
Dr.  H.  C.  Emerson,  177  State  Street,  as  president. 

Worcester  Association   for  the  Relief  and  Control  of 
Tuberculosis  (January,  1904)  : 
'-    Objects:  "To  help  consumptives  and  protect  the  pubHc." 

In  order  to  attain  these  objects  the  association  is  working  for 
the  better  housing  of  the  poor  and  for  well  ventilated,  clean 
Avorkshops,  stores,  and  offices ;  it  is  planning  public  addresses, 
conferences  and  printed  directions  for  sick  and  well. 

The  Association  supplies  to  poor  consumptives,  through  the 
agency  of  the  Associated  Charities,  food,  clothing,  and  sputum 
cups.  It  assists  with  money  those  who  would  otherwise  be  un- 
able to  be  admitted  to  the  State  Sanatorium,  and  is  working  for 
the  establishment  of  a  place  where  incurable  cases  can  be  cared 
for  at  a  low  rate  of  board.     Dr.  A.  C.  Getchell  is  the  president. 

Communications  should  be  addressed  to  Earle  Brown,  Sec- 
retary, 314  Main  Street,  Worcester. 

MINNESOTA 

State  Tuberculosis  Commission  : 

The  work  of  this  Commission  has  consisted  in  securing  the 
establishment  of  a  state  sanatorium.     (See  page  64.) 

The  Chairman  is  Dr.  H.  Longstreet  Taylor,  75  Lowry  Ar- 
cade, Saint  Paul. 

The  Anti-Tuberculosis  Committee  of  the  Associated 
Charities  of  Minneapolis  (December,  1903)  : 

Objects :  To  assist  the  tuberculous  poor,  and  to  instruct 
the  people  in  general  as  to  the  prevention  of  the  spread 
of  the  disease. 

The  work  is  carried  on  in  conjunction  with  the  local  board 
of  health  and  the  dispensaries.  Medical  treatment  is  provided 
through  the  dispensaries  for  patients  able  to  go  to  them.  A 
special  nurse  has  been  engaged  to  visit  the  homes  of  poor  con- 
sumptives in  order  to  instruct  them  how  to  care  for  themselves 
and  how  to  avoid  infecting  others,  and  tO'  discover  what  is 
needed  in  the  way  of  diet,  disinfectants,  and  medicines.  When 
the   family  is  not  able,  financially,   to  procure  these,   they  are 

240 


MISSOURI,   NEW   HAMPSHIRI; 

furnished  through  the  Associated  Charities.  Sputum  cups  and 
simple  printed  information  are  distributed.  The  nurse  keeps  a 
record  of  local  conditions  and  a  history  of  the  patient's  progress. 
Communications  should  be  addressed  to  Edwin  D.  Solen- 
berger,  Secretary,  738  Boston  Block,  Minneapolis. 

MISSOURI 

The  St.  Louis  Society  eor  the  Prevention  oe  Tuberculosis 
(May,  1904)  : 

Objects:  To  limit  the  disease;  to  promote  education  on 
the   subject ;   to   care   for   individual   cases   as   far   as 
possible. 
Much  care  has  been  given  to  perfecting  the  organization  of 
the  society.     The  Executive  Committee  is  a  committee  of  the 
Civic  Improvement  League  and  there  are  several  special  com- 
mittees, as  follows : 

Committee   on   Publicity,   consisting  of  writers   and   the 

editors  of  the  daily  papers. 
Committee  on  Inspection,  which  is  made  up  of  sanitari- 
ans and  ofBcers  of  the  Health  Department. 
Committee  of  Physicians,  on  which  are  representatives  of 

the  various  schools  of  medicine. 
Committee  on  Consultation,  composed  of  the  managers 
of  the  principal  charitable  societies  of  the  city. 
By  public  meetings  and  newspaper  articles  much  general  in- 
terest has  been  aroused,  and  the  society  intends  to  carry  on  an 
energetic  campaign.     The  plan  of  action  includes  the  free  dis- 
tribution of  leaflets,  the  enforcement  of  the  anti-spitting  ordi- 
nance, the  organization  of  a  system  of  inspection  and  of  dis- 
pensaries  in  various   parts   of  the  city,   a   series   of  illustrated 
lectures,  and  the  establishment  of  a  sanatorium  near  the  city. 

Communications  should  be  addressed  to  G.  R.  Blickhahn, 
Secretary,  21st  and  Locust  Streets,  Saint  Louis. 

NEW  HAMPSHIRE 

The  New  Hampshire  Commission  on  a  State  Sanatorium 
EOR  Consumptives  ( Estabhshed  by  a  joint  resolution  of  the 
legislature  in  1901)  : 

A  report  was  made  to  the  governor  in  November,  1902,  and 
a  bill   introduced   to   establish   a   slate   sanatorium.      This   bill 

241 


NKW  HAMPSHIRE,   NEW  JERSEY 

passed  both  branches  of  the  legislature  in  the  January  session 
of  1903,  but  was  vetoed  by  the  governor  as  a  "doubtful  and 
questionable  project."  An  attempt  will  doubtless  T)e  made  in 
1905  to  carry  through  the  project. 

The  Report  of  this  Commission,  printed  at  the  Rumford 
Press,  in  Concord,  New  Hampshire,  is  an  able  presentation  of 
the  reasons  why  a  state  sanatorium  is  needed.  By  a  change  of 
figures  and  geographical  names  the  entire  argument  becomes 
applicable  to  most  of  the  states  of  the  union,  and  should  have  a 
permanent  place  in  the  literature  of  the  subject. 

The  Secretary  of  the  Commission  is  Dr.  Irving  A.  Watson, 
Concord. 

New   Hampshire    Society    for   the    Prevention    of    Con- 
sumption (1904)  : 

Objects :  The  restriction  and  prevention  of  tuberculosis 
in  the  state. 

This  society  was  formed  by  several  physicians.  The  mem- 
bership, however,  although  it  includes  a  large  proportion  of  the 
physicians  of  the  state,  is  not  confined  to  them,  and  the  object 
i.s  to  interest  the  public  rather  than  the  profession.  Litera- 
ture will  be  distributed  and  the  public  interest  will  be  awakened 
through  the  press  and  by  means  of  lectures.  The  movement 
for  a  state  sanatorium,  initiated  by  the  New  Hampshire  Com- 
mission (see  this  page),  will  be  encouraged  and  furthered  in 
every  possible  way.  .: 

Communications  should  be  addressed  to  Dr.  H.  T.  Fontaine^ 
Secretary,  Pembroke  Sanatorium,  Concord. 

NEW   JERSEY 

Anti-Tuberculosis    Committee   of   the    Oranges    (March, 
1904)  : 

Objects:  i.  To  disseminate  information:  a.  to  those 
sufifering  from  the  disease,  as  to  best  treatment  and 
means  of  help ;  b.  to  those  who  come  in  contact  with 
the  disease,  as  to  the  prevention  of  its  spread ;  c.  to 
the  public,  as  to  the  subject  in  general  and  its  bearing 
on  the  social  life  of  the  community.  2.  To  secure  the 
co-operation  of  physicians  and  nurses  in  fighting  the 
disease  and  preventing  its  spread.    3.  To  enlist  the  co- 

'242 


NEW   JKRSEV,   NIvW   Y(JkK 

operation  of  the  proper  charitable  agencies  in  those 
cases  in  which  aid  is  needed. 

The  Committee's  work  thus  far  has  resulted  in  the  issue  of  a 
circular  giving  information  for  consumptives  and  those  living 
with  them;  and  in  the  organization,  in  co-operation  with  the 
Orange  Memorial  Hospital  and  the  Visiting  Xurses'  Settlement, 
of  a  clinic  for  tuberculous  patients.  The  services  of  the  Diet 
Kitchen  and  other  charitable  organizations  have  been  secured 
for  particular  cases  in  which  there  was  special  need  ;  one  public 
lecture  has  been  given,  and  articles  on  the  general  subject  have 
been  contributed  to  the  local  press.  The  work  will  be  carried 
on  and  developed  in  all  these  directions.  • 

Communications  should  be  addressed  to  Miss  Louise  R. 
Pierson,  Secretary,  13  Hillyer  Street,  OraiTge. 

NEW   YORK 

BiNGHAMTON   SOCIETY  FOR  THE   PREVENTION  AND  CuRE  OF  Tu- 

BERCUEOSis  (May,  1904)  : 

Objects:  To  maintain  a  sanatorium  for  the  treatment  of 
consumptives  ;  to  instruct  the  public  in  methods  of  pre- 
vention ;  to  care  for,  in  their  homes,  such  poor  con- 
sumptives   as    cannot    properly    be    received    in    the 
sanatorium. 
A  site  has  been  selected  on  a  hilltop  in  the  northeastern  ex- 
tremity of  the  city,  and  almost  enough  monev  has  been  subscribed 
for  the  buildings.     It  is  hoped  that  patients  can  be  received  this 
winter.     There  has  been  some  opposition  to  the  erection  of  a 
sanatorium,  on  the  part  of  interested  land-owners,  but   it  has 
done  no  more  serious  harm  than  somewhat  to  retard  the  pro- 
gress. 

Communications  should  be  addressed  to  Charles  W.  Feth- 
erolf,  Secretary,  9  Lincoln  Avenue,  Binghamton. 

Tenement  and  Tuberculosis  Committee  of  the  Buffalo 
Charity  Organization  Societv  (March  18,  1904 j  : 

Objects:    The  education  of  the  public  in  regard  to  tuber- 
culosis, and  the  relief  of  poor  consumptives;    the  im- 
provement of  the  housing  of  the  poor. 
Active  work  was  begun  on  May  i  by  the  special  agent  of 
the  committee.     During  the  summer  of  1904  most  of  the  time 
has  been  given  to  tenement-house  work.     Upwards  of  thirty  of 

243 


NEW  YORK 

the  worst  tenement  houses  have  been  summarily  vacated,  and 
forty-one  indictments  against  different  owners  are  now  before 
the  grand  jury. 

On  the  tuberculosis  side  the  work  of  the  committee  has  so 
far  consisted  of  the  publication  and  distribution  of  many  thou- 
sand copies,  in  English,  Polish,  Italian  and  German,  of  cards  and 
pamphlets  similar  to  those  issued  by  the  New  York  Charity 
Organization  Society.  The  Department  of  Education  has 
agreed  to  introduce  the  committee's  literature  into  the  curricu- 
lum of  the  public  schools.  Prizes  of  ten  and  five  dollars  have 
been  offered  in  each  high  school  for  the  best  essay  on  the  pre- 
vention of  consumption.  Several  public  meetings  are  planned 
for  the  winter. 

Close  co-operation  has  been  established  with  the  department 
of  health,  and  the  department  has  prepared  an  elaborate  map 
of  Buffalo,  showing  the  location  of  each  death  from  tuberculosis 
in  the  last  five  years.  The  committee  has  made  a  card  index 
of  all  deaths  from  tuberculosis  and  of  all  living  cases  of  tubercu- 
losis reported  to  the  health  department  for  the  last  five  years. 
These  have  been  arranged  by  streets  and  house  numbers,  and 
all  houses  which  show  more  than  one  case  are  reported  to  the 
health  department  for  special  fumigation. 

Communications  may  be  addressed  to  any  one  of  the  follow- 
ing: Dr.  P.  W.  Van  Peyma,  Chairman,  445  William  Street; 
Frederic  Almy,  Secretary,   165   Swan   Street. 

Committee  on  the  Prevention  oe  Tuberculosis  of  the 
Charity  Organization  Society  oe  the  City  oe  New 
York  (June,  1902)  : 

Objects:  i.  Research  into  the  social  aspects  of  tuber- 
culosis. 2.  Education  in  means  of  prevention  and 
proper  methods  of  cure.  3.  The  advancement  of 
movements  to  provide  special  hospitals,  sanatoriums 
and  dispensaries  for  consumptive  adults  and  for  scrof- 
ulous and  tuberculous  children.  4.  The  encourage- 
ment of  measures  which,  by  improving  the  conditions 
of  life,  tend  to  decrease  the  prevalence  of  tuberculosis. 
5.  Co-operation  with  the  mvmicipal  departments  whose 
heads  are  members  of  the  Committee  and  whose  work, 
directly  or  indirectly,  affects  the  conditions  which 
determine  the  prevalence  of  tuberculosis. 

244 


NEW    YORK 

The  results  of  an  investigation  into  the  social  aspects  of  the 
problem,  with  special  reference  to  New  York  City,  may  be 
found  in  full  in  the  Handbook  on  the  Prevoition  of  Ttibercu- 
losis,  published  by  the  Committee  as  its  first  annual  report. 

The  education  of  the  public  in  regard  to  the  nature  of  the 
disease  and  the  precautions  which  should  be  taken  to  prevent 
its  spread  has  been  undertaken  by  means  of  lectures  and  litera- 
ture. The  lectures  during  the  first  two  seasons  reached  an 
aggregate  audience  of  20,000.  They  were  delivered  in  a  variety 
of  places  and  in  many  different  languages.  Literature  in  as 
great  variety  has  been  distributed  in  large  quantities  through 
the  city.  A  manifesto  expressing  the  opinion  of  the  committee 
in  regard  to  "specifics"  and  "sure  cures"  has  been  widely  circu- 
lated. The  Handbook  referred  to  above  includes  not  only  a 
review  of  the  Committee's  origin,  scope,  and  methods  of  work, 
but  also  much  of  the  material  collected  and  prepared  for  lectures 
and  for  publication,  and  was  issued  in  the  hope  that  it  would 
be  of  service  to  those  organizing  similar  movements  elsewhere. 

A  considerable  part  of  the  efforts  of  the  Committee  has  been 
directed  tow^ard  encouraging  movements  for  increasing  dis- 
pensary facilities  and  sanatorium  accommodations,  by  helping  to 
create  a  popular  sentiment  on  the  subject,  by  co-operation  with 
the  Department  of  Health  and  the  Com.missioner  of  Charities, 
and  by  attempts  to  influence  legislation. 

The  Charity  Organization  Society,  through  its  regular  chan- 
nels, secures  relief  for  great  numbers  of  persons  suffering  from 
tuberculosis,  and  consequently  no  direct  relief  work  is  done  by 
it  through  this  committee. 

The  Committee  has  attentively  watched  proposed  legislation 
bearing  on  the  health  of  tenement  dwellers  and  has  used  all  its 
influence  against  changes  in  the  tenement-house  law.  It  has  also 
opposed  a  proposition  w^hich  would  have  had  the  effect  of  de- 
creasing the  park  area  in  the  crowded  districts  and  has  done  all 
that  it  could  to  secure  the  establishment  of  new  playgrounds. 

During  the  winter  of  1904  the  interest  of  the  United  Gar- 
ment Workers  of  America  and  the  Central  Federated  Union 
was  aroused,  with  the  result  that  these  two  influential  labor 
unions  promptly  began  a  campaign  among  their  own  members. 
This  feature  of  the  Committee's  work  is  capable  of  indefinite: 
extension  and  holds  promise  of  the  most  excellent  results. 

Communications  should  be  addressed  to  Paul  Kennaday^, 
Secretary.  105  East  22d  Street. 

245  " 


new  york,  ohio 

The  Rochester  Public  Health  Association  (1898)  : 

Object :  To  promote  sanitary  reforms  and  to  improve  the 
public  health. 

In  May,  1904,  the  Association  undertook  definite  work  for 
the  prevention  of  tuberculosis,  by  opening  a  hospital  for  incipi- 
ent cases  (see  page  102).  As  it  was  impracticable  to  provide 
at  once  suitable  hospital  accommodations  for  advanced  cases, 
plans  were  made  for  treating  them  at  home.  For  this  purpose 
the  services  of  a  trained  nurse  have  been  secured  and  she  began 
work  on  September  10.  The  nurse  instructs  the  patient  how  to 
care  for  himself,  and  how  to  protect  others  by  destroying  the 
sputum.  She  provides  sputum  cups  and  paper  napkins,  and  in 
certain  cases  milk  and  eggs.  Printed  literature  on  the  subject 
of  the  prevention  of  the  disease  will  be  provided.  The  nurse 
will  also  provide  for  and  oversee  the  cleaning  and  disinfecting 
of  those  houses  from  which  tuberculous  patients  have  moved, 
or  in  which  they  have  died. 

Communications  should  be  addressed  to  Dr.  M.  E.  Leary,  32 
South  Washington  Street. 

OHIO 

The  State  Tuberculosis  Commission  was  appointed  on 
September  16,  1902,  under  the  authority  of  a  joint  resolution 
passed  by  the  legislature  in  April  of  the  same  year,  "to  investi- 
gate and  report  upon  the  feasibility  ...  of  successfully 
treating  persons  suffering  from  tuberculosis,  and  especially 
consumption,  in  sanatoria  located  within  the  state  of  Ohio;  also 
upon  the  desirability  of  establishing  such  institutions." 

On  April  30,  1903,  the  Commission  presented  to  the  Gov- 
ernor a  report  dealing  with  the  causes  of  tuberculosis  ;  its  preva- 
lence in  Ohio ;  the  economic  loss  resulting  from  it ;  the  possi- 
bility of  cure  as  demonstrated  by  the  experience  of  German  and 
American  sanatoriums ;  a  comparison  of  the  climate  of  various 
points  in  Ohio,  in  regard  to  temperature,  precipitation,  and 
weather,  with  the  climatic  conditions  under  which  successful 
sanatoriums  are  conducted ;  the  probable  cost  and  the  desirable 
features  of  site  and  buildings ;  and  the  results  of  an  inquiry 
sent  to  thirty  experts  in  the  treatment  of  consumption,  in  regard 
to  the  character  of  employment  suitable  for  convalescents. 

As  a  result  of  its  investigation  the  Commission  recommended 
and  urged  "the  establishment  of  a  sanatorium  for  the  treatment 

246 


OHIO,    P]iNNSYL,VANIA 

of  tubercular  patients  on  a  scale  sufificiently  large  to  give  this 
subject  a  fair  trial,  believing  that  the  outcome  will  fully  justify 
the  expenditure  required  for  such  purpose." 

The  Commission  went  out  of  office  on  the  presentation  of 
its  report. 

J.  Warren  Smith,  of  Columbus,  was  the  Secretary. 

Ohio  Society  for  thi:  Prevention  of  Tubercueosis  (1902)  : 
Object:    To  educate  the  public  as  to  the  causes  of  tuber- 
culosis and  the  importance  of  preventing  it. 

Pamphlets  have  been  distributed.  A  series  of  articles  in  re- 
gard to  the  cause,  prevention,  and  cure  of  tuberculosis  has  been 
published  in  over  three  hundred  daily  and  weekly  newspapers  of 
the  state.  The  appointment  of  the  State  Commission  which 
should  determine  the  desirability  and  feasibility  of  sanatoriums 
in  Ohio,  was  secured  by  this  society. 

It  is  planned  to  increase  the  membership  of  the  society  and 
to  continue  the  educational  work.  A  bill  to  establish  a  state 
sanatorium  has  been  put  through  the  legislature  by  the  Society, 
a  new  Commission  has  been  appointed  to  take  charge  of  select- 
ing a  site  and  building  the  sanatorium,  and  $35,000  has  been 
appropriated  to  begin  work. 

Communications  should  be  addressed  to  C.  O.  Probst,  M.  D., 
Secretary,  Office  of  the  State  Board  of  Health,  Columbus. 

PENNSYLVANIA 

Pennsylvania  Society  for  the  Prevention  of  Tuberculo- 
sis (Organized,  1892;  incorporated,  1895): 

Objects:  To  prevent  tuberculosis:  i.  By  promulgating 
the  doctrine  of  the  contagiousness  of  the  disease.  2. 
By  instructing  the  public  in  practical  methods  of 
avoidance  and  prevention.  3.  By  visiting  the  con- 
sumptive poor  and  supplying  them  with  the  necessary 
materials  with  which  to  protect  themselves  against  the 
disease,  and  instructing  them  in  their  use.  4.  By 
furnishing  the  consumptive  poor  with  hospital  treat- 
ment. 5.  By  co-operating  with  boards  of  health  in 
such  measures  as  they  may  adopt  for  the  prevention 
of  the  disease.  6.  By  advocating  the  enactment  of 
appropriate  laws  for  the  prevention  of  the  disease. 
•    7.  By  such  other  methods  as  the  Society  may  from  time 

to  time  adopt. 

247 


PENNSYLVANIA 

Since  its  organization  this  Society,  the  first  of  its  kind  in 
America,  has  contributed  to  the  education  of  the  pubHc  by  print- 
ing and  widely  distributing  six  tracts  and  by  holding  popular 
lectures  ;  it  has  taken  charge  of  monev  to  be  applied  for  the 
support  of  poor  consumptives  in  hospitals ;  it  has  been  instru- 
mental in  securing  the  passage  of  an  anti-expectoration  ordi- 
nance applying  to  street  cars  and  railroad  offices,  and  improve- 
ment in  methods  of  street-cleaning ;  it  has  used  its  influence  to 
bring  about  special  provision  for  the  tuberculous  patients  in  the 
Philadelphia  Hospital,  and  to  arouse  public  sentiment  in  favor 
of  a  state  sanatorium ;  and  it  has  encouraged  the  enforcement 
of  pure-food  laws  by  the  Pennsylvania  Dairy  and  Food  Com- 
mission, a  matter  which  affects  consumptives  indirectly  but 
vitally. 

It  is  planned  to  continue  the  educational  work ;  to  work  for 
appropriations  for  several  state  camps  on  the  forestry  reserva- 
tions similar  to  the  one  at  Mont  Alto,  described  on  page  119; 
and  to  assist  the  Philadelphia  Department  of  Public  Safety, 
in  every  possible  way,  in  its  endeavor  to  secure  registration  of 
cases  of  tuberculosis  and  in  its  work  for  better  sanitary  condi- 
tions, whether  in  streets,  factories,  shops,  or  dwellings. 

The  offices  of  the  Society  are  in  the  Academy  of  Natural  Sci- 
ences, of  w'hich  Dr.  Samuel  G.  Dixon  is  President,  and  which 
is  located  at  Nineteenth  and  Race  Streets,  Philadelphia. 

Communications  should  be  addressed  either  to  the  President. 
Dr.  Howard  S.  Anders,  1836  Wallace  Street,  or  to  the  Secre- 
tary, Dr.  Lewis  Brinton,  1423  Spruce  Street. 

The  Henry  Phipps  Institute  for  the  Study,  Treatment, 
AND  Prevention  oe  Tuberculosis  (Founded  February, 
1903),  238  Pine  Street,  Philadelphia: 

The  objects  of  the  Henry  Phipps  Institute  are  explicitly 
stated  in  its  name.  It  is  endowed  by  ]\Ir.  Henry  Phipps,  of 
Pittsburg.  Dr.  Lawrence  F.  Flick  is  the  medical  director,  and 
Dr.  Mazyck  P.  Ravenel  is  his  assistant. 

The  Institute  maintains  a  hospital  for  advanced  cases,  a  free 
clinic,  and  a  laboratory  for  research,  all  of  which  are  described 
below.  During  the  winter  of  IQ03-4  a  series  of  lectures  was 
held,  open  to  the  public,  and  given  by  speciaHsts  of  world-wide 
reputation.  Further  arrangements  for  popular  lectures  and 
other  educational  work  are  being  made,   and  it  is   planned  to 

248 


PSNNSYIvVANIA 

develop  the  facilities  for  research,  as  well  as  to  extend  the  work 
of  treatment  that  has  been  organized  in  the  first  year  of  the 
Institute's  existence. 

The  Hospital,  238  Pine  Street. 

For  destitute  persons  in  an  advanced  stage  of  tuberculo- 
sis ;  if  applicants  are  able  to  pay  anything  they  are 
referred  to  some  suitable  place. 

Capacity :  52. 

There  are  no  charges. 

Six  physicians  are  on  duty  in  the  Hospital. 

The  present  temporary  quarters  will  be  exchanged  as  soon 
as  possible  for  buildings  better  adapted  to  the  work.  A  training 
school  for  nurses  is  maintained. 

The  Dispensary,  also  at  238  Pine  Street. 

Exclusively  for  the  treatment  of  tuberculosis. 

Daily  :   1 1  a.  :m.  to  5  p.  m. 

There  are  no  charges. 

The  physicians  in  charge  of  the  clinic  number  sixteen, 

working  under  the  general  supervision  of  the  medical 

director  of  the  Institute. 

In  the  course  of  the  first  year  2,040  cases  were  treated. 
Two  nurses  are  employed  for  inspection  of  homes,  "to  see  what 
the  patients  are  doing  and  give  further  instructions."  Milk  is 
provided  at  the  patient's  home  when  the  physician  sees  fit. 
Each  patient  receives  verbal,  as  well  as  printed  instructions. 
The  latter  are  given  in  two  forms,  a  folder  for  the  pocket  and 
a  large  card  to  hang  in  the  living-room.  Sputum  cups  also  are 
supplied,  and  Japanese  napkins. 

The  Laboratory,  also  at  238  Pine  Street. 

The  laboratory  is  equipped  for  original  research.  The  en- 
tire medical  staff  works  in  the  laboratory,  under  the  direction  of 
Dr.  ]\I.  P.  Ravenel,  Assistant  Medical  Director  and  Bacteriolo- 
gist. There  are  also  pathological,  laryngological,  neurological, 
and  dermatological  departments  connected  with  the  Institute. 

Applications  for  admission  to  the  Hospital  and  inquiries  in 
regard  to  any  part  of  the  work  of  the  Institute  should  be  ad- 
dressed to  Dr.  Lawrence  F.  Flick,  Medical  Director,  238  Pine 
Street,  Philadelphia. 

249 


p£;nnsylvania,  rhode  island 

In  Reading  the  organization  of  a  society  for  the  care  of 
poor  consumptives  is  now  being  completed. 

The  Scranton  Society  eor  tpie  Prevention  and  Cure  oe 
Consumption   (Incorporated  January  26,  1903)  : 

Objects:  To  provide  facihties  for  the  treatment  of  the 
consumptives  of  Scranton,  whether  in  a  sanatorium  or 
at  a  dispensary  or  in  their  homes ;  and  to  educate  the 
public  by  circulars  and  newspaper  articles. 

At  the  first  meeting  after  the  organization  of  this  society 
it  was  decided  that  the  most  pressing  needs  in  Scranton  were 
(i)  a  place  where  a  poor  consumptive  would  have  a  chance  for 
life,  and  (2)  the  prevention  of  the  spread  of  infection.  The 
Dispensary  and  Visiting  Nurse  system  (see  page  167)  were 
established  at  once,  and  work  for  a  sanatorium  was  begun.  In 
the  first  year  $17,000  was  contributed  for  the  work  of  the 
society.  Within  seven  months  from  the  date  of  organization 
a  farm  had  been  bought  and  a  sanatorium  building  completed 
(see  page  128). 

The  Visiting  Nurses  care  for  destitute  consumptives  too  ill 
to  go  to  the  Dispensary,  as  well  as  for  Dispensary  cases  need- 
ing special  attention.  They  see  that  sanitary  rules  are  carried 
out  while  the  patient  lives  and  that  the  rooms  are  properly  dis- 
infected after  a  death. 

A  four-page  leaflet,  called  "The  Struggle  Against  Consump- 
tion," is  published  quarterly  by  the  society,  for  the  purpose  of 
keeping  contributors  and  others  interested  informed  in  regard 
to  the  progress  of  the  work. 

Communications  should  be  addressed  to  Dr.  J.  M.  Wain- 
wright,  ^2^  Linden  Street. 


RHODE  ISLAND 

Newport  Association  eor  the  Relief,  Control,  and  Pre- 
vention oE  Tuberculosis  (March,  1904)  : 

Objects:  The  relief  of  tuberculosis  in  all  its  forms  and 
relations.  2.  The  dissemination  of  knowledge  con- 
cerning the  causes,  treatment,  and  prevention  of  tuber- 
culosis. 3.  The  encouragement  of  means  of  prevention 
and  scientific  treatment  of  tuberculosis. 

250 


RHODU   ISLAND,   VERMONT 

The  work  of  the  Association  is  in  charge  of  the  following 
committees :  Finance  Committee,  Dispensary  Committee,  Milk 
Committee,  Committee  on  Sputum  Cups ;  on  Education,  Lec- 
tures, ets. ;  on  Relief  and  Care,  on  Clinic  and  Hygiene ;  and  a 
Committee  to  inform  the  teachers  and  the  pupils  in  public  and 
parochial  schools  regarding  the  prevention  and  spread  of  tuber- 
culosis. 

The  work  has  been  begun  by  placing  cards  regarding  spitting 
in  the  cars  and  other  public  places,  by  distributing  widely  a  leaf- 
let explaining  the  "platform"  of  the  Association,  and  by  arrang- 
ing a  public  lecture  on  the  subject  by  Dr.  Henry  Barton  Jacobs. 
The  Committee  on  Relief  and  Care  has  sent  to  each  physician  in 
the  city  a  letter  stating  its  willingness  to  care  for  any  needy  case, 
with  assurances  that  the  physician's  instructions  will  be  ex- 
plicitly followed.  All  patients  in  need  are  furnished  by  the 
Association  with  proper  nourishment,  as  prescribed  by  the  phy- 
sician. Sputum  cups  for  the  room  and  pocket  cuspidors  are  sup- 
plied to  all  patients.  Money  is  now  being  subscribed  for  a 
temporary  sanatorium  and  for  home  care. 

The  Dispensary  Committee,  consisting  of  five  physicians, 
examines  all  patients  coming  under  the  charge  of  the  Associa- 
tion. If  the  Committee  decides  that  the  case  is  a  hopeful  one 
the  patient,  if  walling,  is  sent  to  the  camp  at  Pine  Ridge,  or,  if 
arrangements  can  be  made,  to  some  sanatorium. 

Preparations  are  being  made  for  lectures  to  the  teachers  and 
pupils  of  the  public  and  parochial  schools,  and  one  lecture  has 
been  given  to  the  teachers,  by  Dr.  Jacobs. 

Communications  should  be  addressed  to  Christopher  Easton, 
Secretarv. 


VERMONT 

State    Tuberculosis    Commission     (Appointed    January    i. 
1903): 

Objects:  To  investigate  the  prevalence  of  tuberculosis  in 
Vermont,  and  to  recommend  such  measures  as  may 
seem  advisable  to  control  the  disease ;  also  to  submit 
to  the  legislature  of  1904  plans  and  suggestions  for 
the  location,  etc.,  of  a  state  sanatorium,  if  such  insti- 
tution should  seem  desirable. 

251 


VI;RM0NT,    WISCONSIN 

Numerous  meetings  have  been  held  with  the  various  county 
medical  societies,  in  order  to  enlist  the  support  of  the  medical 
profession ;  important  sanatoriums  have  been  visited ;  the  statis- 
tics of  deaths  from  tuberculosis  and  the  climatic  characteristics 
of  the  state  have  been  studied. 

It  is  planned  to  hold  public  meetings  in  all  the  larger  towns 
of  the  state,  with  the  object  of  interesting  the  people  in  general 
in  the  project  of  a  state  sanatorium.  A  report  covering  the 
whole  subject  will  be  made  to  the  legislature  in  1904. 

Communications  should  be  addressed  to  Dr.  H.  Edwin 
Lewis,  Secretary,  Burlington. 

Vermont  Socie^ty  for  the;  Study  and  Pre;vsntion  op'  Tuber- 
culosis (Organized  September,  1902)  : 

Objects :  To  encourage  the  study  of  tuberculosis  in  its 
medical,  municipal,  and  sanitary  aspects ;  to  assist  in 
the  establishment  and  maintenance  of  a  state  sana- 
torium for  consumptives ;  to  disseminate  literature  and 
proper  information  concerning  the  prevention  of  tuber- 
culosis and  to  support  all  public  measures  tending  to 
control  and  limit  the  spread  of  the  disease." 

Inquiries  should  be  addressed  to  Dr.  H.  E.  Lewis,  Burling- 
ton. 

WISCONSIN 

State  Tuberculosis  Commission  (Appointed  May,  1903)  : 

Objects:  To  investigate  the  prevalence  of  tuberculosis  in 
the  state  and  to  report  to  the  legislature  of  1904  in 
regard  to>  the  desirability  of  establishing  a  sanatorium 
for  the  treatment  of  the  disease,  with  recommendations 
as  to  a  site. 

Statistical  data  as  to  the  prevalence  and  distribution  of  the 
disease  in  Wisconsin  are  being  collected.  A  report  showing  the 
need  of  establishing  a  sanatorium  is  to  be  presented  to  the  legis- 
lature. An  eligible  site  for  its  location  will  be  recommended 
by  the  Commission,  after  studying  the  conditions  which  should 
be  considered  in  making  such  selection. 

Inquiries  should  be  addressed  to  H.  L.  Russell,  Secretary, 
University  of  Wisconsin,  Madison. 

252 


CANADA 

CANADA 

TnK  Canadian  Association  for  the:  Pri^vi^ntion  of  Con- 
sumption AND  Other  Forms  of  Tuberculosis  (April, 
1901)  : 

Object:  "To  prevent  the  prevalence  of  consumption  and 

other  forms  of  tuberculosis  in  Canada : 
"  ( I )    By  enlisting  the  co-operation  of  the  people  general- 
ly with  the  medical  profession,  and  by  increasing 
the  interest  in  means  for  lessening  the  ravages  of 
the  disease; 
"(2)    By  investigating  into  the  prevalence  of  tuberculosis 
in  Canada  and  by  collecting  and  publishing  use- 
ful information ; 
''(3)    By  advocating  the  enactment  of  appropriate  laws 

for  the  prevention  of  the  disease ; 
"(4)    By     co-operating     with    governments     and     other 
organizations   in  measures  adopted  for  the  pre- 
vention of  the  disease ; 
''(5)    By  promoting  the  organization  and  work  of  Pro- 
vincial Associations  and  their  affiliation  with  the 
Canadian  Association ; 
"(6)    By  encouraging  all  concerned  to  provide  suitable 
accommodation    for    consumptives,    in    hospitals, 
sanatoria,  and  otherwise ; 
"(7)    By    such    other   methods    as   the   Association   may 
from  time  to  time  adopt." 
Since  its  organization  the  Association  has  put  into  circulation 
T. 250,000  pages  of  literature  relating  tO'  the  cause  and  prevention 
of  tuberculosis,  and  lectures  have  been  given  by  the  secretary 
in  about  seventy-five  towns  and  cities.     Provincial  associations, 
and  associations  in  cities  and  towns  located  in  provinces  in  which 
there  is  no  general  organization,  are  affiliated  with  the  Canadian 
Association.     The  affiliated   organizations   include   the   Ontario 
League,   the   Montreal   League,    and   the    St.    Francis    District 
League,  the  Toronto  Anti-Consumption  League,  and  the  British 
Columbia    Association    for   the    Prevention    and    Treatment   of 
Consumption. 

It  is  planned  to  continue  the  work  for  all  objects  on  an  in- 
creasingly large  scale,  as  the  liberality  of  the  government  and 
of  private  contributors  permits. 

Communications  should  be  addressed  to  the  secretary.  Rev. 
William  Moore,  D.  D.,  128  Wellington  Street,  Ottawa,  Ontario. 

253 


CANADA 

Thd   British    Columbia    Society   for   the   Prevention    of 
Tuberculosis   (Organized  February,  1904)  : 

Object :  To  secure  the  establishment  of  sanatoriums. 
Several    local    societies    have   been    formed   throughout   the 

province,  and  appeals  for  support,  both  moral  and  financial,  have 

been  widely  published. 

Communications  should  be  addressed  to  Dr.   C.  J.  Fagan, 

Secretary  Provincial  Board  of  Health,  Victoria. 

The  Montreal  League  for  the  Prevention  of  Tubercu- 
losis, 691  Dorchester  Street  (December,  1902)  : 

Objects:  To  educate  the  public  upon  the  most  simple 
methods   for  preventing  the  ravages  of  tuberculosis ; 
to  establish,  as  soon  as  possible,  a  home  for  the  incura- 
ble cases   of  the  disease,   and  a  sanatorium  or  sana- 
toriums for  the  hopeful  cases ;  pending  the  establish- 
ment of  these  institutions,  to  care  for  indigent  cases  in 
their  own  homes,  in  co-operation  with  the  city  board  of 
health ;  to  disinfect  every  house  in  which  a  death  from 
tuberculosis  has  occurred. 
During  the  year  ending  June,   1904,  200  cases  were  cared 
for,  1,300  visits  were  paid  by  the  inspector,  8,000  cuspidors  were 
distributed,  and  30  patients  were  supported  at  institutions  and 
given  various  other  forms  of  assistance.     In  the  course  of  the 
seven  months  between  March  i  and  October  i,  1904,  359  dis- 
mfections   were  made.     Every  house   in   which  a  death   from 
tuberculosis  occurs  is  visited  and  formalin  disinfection  is  urged 
upon  the  occupant.     In  nearly  all  cases  the  advice  is  acted  upon. 
A  special  dispensary  for  the  treatment  of  tuberculosis  has  been 
opened  (see  page  159). 

It  is  to  be  hoped  that  shacks  and  barracks  may  soon  be 
erected,  near  the  city,  where  patients  in  all  stages  of  the  disease 
can  be  treated. 

Communications  should  be  addressed  to  the  Honorary  Sec- 
retary, 691  Dorchester  Street,  ]\Iontreal. 

The  District  of  St.  Francis  League  for  the  Prevention 
OF  Tuberculosis  (Organized  July,  1903)  : 

Object :  To  prevent  the  spread  of  tuberculosis,  by  enlist- 
ing the  co-operation  of  the  public,  by  rendering  assist- 
ance to  indigent  consumptives,  and  by  promoting  de- 
sirable legislation. 

254 


CAN  MM 

Local  societies  have  been  formed  in  each  city  and  town  in 
the  district,  the  chairman  of  each  being  a  member  of  the  execu- 
tive committee  of  the  district  league.  A  lecture  tour  of  the 
district  has  been  made  by  the  secretary  of  the  Canadian  Asso- 
ciation, in  the  course  of  which  io,ooo  leaflets  were  distributed. 
Lectures  have  been  given  by  physicians  on  Sunday  afternoons 
in  all  of  the  churches  and  on  week  days  to  advanced  classes  in 
the  public  schools  and  colleges. 

As  a  preliminary  step  toward  establishing  a  free  dispensary 
for  consumptives  arrangements  have  been  made  for  two  phy- 
sicians to  act  as  examining  and  treating  physicians  for  two 
months  at  a  time.  These  physicians  give  their  services  free 
to  indigent  patients.  A  laboratory  is  established,  where  sputum 
is  examined,  and  where  X-ray  examinations  are  made. 

It  is  planned  to  secure  the  passage  of  an  anti-expectoration 
law,  and  to  arouse  public  sentiment  for  a  sanatorium  for  the  con- 
sumptives of  the  eastern  townships  of  Quebec. 

Communications  should  be  addressed  to  the  secretary,  Dr. 
E.  J.  Williams,  Sherbrooke,  Quebec. 

The  Anti-Consumption  League;  of  Toronto  (1889)  : 

Object :  To  secure  a  municipal  sanatorium  for  the  treat- 
ment of  consumption. 

The  efforts  of  this  League  have  been  devoted  to  arousing 
public  interest  in  the  establishment  of  a  sanatorium.  Through 
its  efforts  provincial  legislation  was  secured  in  1900  in  the  form 
of  an  act  permitting  any  municipality  to  establish  such  a  sana- 
torium and  providing  that  grants  may  be  made  from  the  revenues 
of  the  province  to  the  amount  of  $4,000  for  construction  and  a 
per  capita  allowance  of  $1.50  per  week  for  maintenance.  The 
question  of  an  appropriation  of  $50,000  by  the  city  was  submitted 
to  the  people  in  January,  1904,  and  approved  by  a  majority  of 
403  votes,  but  the  appropriation  has  not  yet  been  made.  The 
League  continues  its  agitation. 

Communications  should  be  addressed  to  E.  J.  Barrick,  M.  D., 
President,  60  Bond  Street. 


255 


INDEX 

TO    SANATORIUMS,    HOSPITALS    AND    CAMPS,    CLASSIFIED 

ACCORDING    TO    CLASS    OF    PATIENTS 

RECEIVED  AND  CHARGES, 


AND 


SUMMARY 

OF    EXISTING    PROVISIONS    FOR    THE    TREATMENT     AND 

THE  PREVENTION  OF  TUBERCULOSIS  IN  THE 

UNITED     STATES     AND     CANADA 


I  K  33  E  X  . 

SANATORIUMS,    HOSPITALS   AND   CAMPS,    CLASSIFIED    AC- 
ACCORDING     TO     CLASS     OF      PATIENTS 
RECEIVED  AND  CHARGES 


Some  institutions  are  necessarily  indexed  in  more  than  one  class. 
''Denotes  a  general  hospital,  with  a  separate  building,  tents,  or  wards,  for  tuberculosis. 

PAGE 

I.     All  Stages  of  pulmonary  tuberculosis  received. 
a.  Free. 

I.   Colorado  :  Jewish  Consumptives'  Relief  Society,  Denver.  35 

*2.  District  of  Columbia  :  Washington  Asylum  Hospital. ...  42 

*3.  Florida  :    Naval  Hospital,  Pensacola   42 

*4.  Hawaii:    Home  for  Incurables,  Honolulu 43 

5.  Illinois:    Cook  Co.  Hospital  for  Consumptives,  Dunning.  45 

6.  Indiana:    St.  Rochus  Hospital,  Ft.  Wayne 46 

7.  Maryland:    City  Hospital  for  Consumptives,  Baltimore.  .  50 
*8.  Massachusetts:    Almshouse  and  Hospital,  Boston 57 

9.               "                Channing  Home,  Boston 57 

10.               •'                Free  Home  for  Consumptives,  Boston  .  .  59 

*ii.               "                House  of  the  Good  Samaritan,  Boston. .  59 

*I2.               "                State  Hospital,  Tewkesbury 62 

*I3.  Michigan:    Wayne  County  House,  Eloise 64 

*I4.  Missouri:    Emergency  City  Hospital  No.  2,  St.  Louis.  ...  67 

15.  New  Me.xico:    St.  Joseph  Sanatorium,  Albuquerque 69 

16.  "           "           U.  S.  General  Hospital,  Ft.  Bayard 71 

17.  "  "  Public  Health  and  Marine  Hospital  Serv- 

ice Sanatorium,  Ft.  Stanton 72 

18.  New  York:    Home  for  Consum.ptives,  Brooklyn 85 

Kings  County  Hospital,  Brooklyn 85 

St.  Peter's  Hospital,  Brooklyn 86 

Erie  County  Consumption  Hospital,  Buffalo.  87 

Westchester  County  Hospital,  East  View. . .  87 

23.  "         "        Tuberculosis  Infirmary,  New  York  City. .. .  94 

24.  "         "        Riverside  Sanatorium  , New  York  City 95 

25.  "         "        Seton  Hospital,  New  York  City 95 

*26.      "         "        Lincoln  Hospital,^  New  York  City 98 

27.  Ohio:    Branch  Hospital  for  Consumptives,  Cincinnati.  .  .  115 

28.  "        Tuberculosis  Sanatorium,  Cleveland 115 

*29.       "        Miami  Valley  Hospital,  Dayton 117 

*3o.  Pennsylvania:    General  Hospital,  Philadelphia 121 

31.  "               Hospital  for  Diseases  of  the  Lungs,  Phila- 
delphia    121 

32.  Pennsylvania:    House  of  Mercy,     Philadelphia 122 

33.  "               Lucien  Moss  Home,           "          124 

34.  "               Tuberculosis  Hospital,  Pittsburg 126 

a.  A  few  pay  patients  are  received. 

259 


■*i9. 

*20. 

21. 

*22. 


PAGE 

*35.  Rhode  Island:    State  Almshouse,  Howard 133 

*36.  Texas:    Sisters'  Hospital,  El  Paso 136 

*37-  Washington:    King  County  Hospital,  Seattle 137 

b.  Charges  not  more  Ihan^io  per  week. 

1.  California:    The  Settlement,'^  Redlands 24 

2.  Colorado:    The  Home,  Denver. 33 

*3.  Hawaii:    Home  for  Incurables,  Honolulu 43 

4.  Maryland:    Hospital    for     Consumptives    of     Maryland, 

Towson 51 

*5.  New  Jersey:    Memorial  Hospital,  Orange 69 

6.  Pennsylvania:    Mt.  Jefferson  Sanatorium,  Lansford 118 

7.  "               West  Mountain  Sanatorium,  Scranton.  . .  128 
*8.  Rhode  Island:    St,  Joseph's  Hospital,  Providence 133 

c.  Charges  over  $10  per  week. 

*i.  Arizona:    Mercy  Hospital,  Phoenix 15 

*2.          "          St.  Mary's  Hospital,''  Tucson 16 

3.  California:    Esperanza,  Altadena 17 

*4.  Colorado:    Glockner  Sanitarium,'^  Colorado  Springs 27 

5.  "            The  Home,  Denver 33 

6.  Missouri:    Mt.  St.  Rose  Sanatorium,"  '^  St.  Louis 67 

7.  New  Mexico:    St.  Joseph  Sanatorium,  Albuquerque 69 

8.  "          "           St.  Anthony's  Sanitarium,'^  E.  Las  Vegas.  71 
*9.      "          "           St.  Vincent  Sanitarium,"  Santa  Fe 75 

10.  New  York:    Seton  Hospital,  New  York  City 95 

11.  "          "       Rumenapp  Cottage,'^  Saranac  Lake 108 

*I2.  North  Carolina:    St.  Joseph  Sanitarium,  Asheville :  109 

13.  Pennsylvania:    Rush   Hospital,*^  Philadelphia 124 

14.  "               Dermady  Sanatorium,  Philadelphia 126 

II.     For  early  cases  of  pulmonary  tuberculosis,  exclusively  or  chiefly. 

a.  Free. 

1.  Colorado:    National  Jewish  Hospital,  Denver 34 

2.  Illinois:    St.  Ann's  Sanitarium,  Chicago 43 

3.  Maine:    Maine  Sanatorium,  Hebron 49 

4.  New  York:    Montefiore     Country    Sanitarium,    Bedford 

Station 84 

5.  New  York:    Loomis  Sanatorium,  Annex,  Liberty 91 

6.  "         "        Sanatorium  Gabriels,  Paul  Smith's 102 

*7.      "         "        All  Saints'  Home,  Verbank 108 

8.  Ohio:    Western  Hill  Hospital,  Price  Hill 117 

9.  Pennsylvi-nia:    Free    Hospital    for   Poor    Consumptives, 

White  Haven 1 29 

10.  Wisconsin.    Health  Park;  Tomahawk 138 

11.  Canada:    Provincial  Sanatorium,  Kentville,  N.  S 140 

12.  "           Muskoka  Free  Hospital,  Gravenhurst,  Ont 143 

13.  "           Provincial  Sanatorium,  Quebec 145 

a,  A  few  pay  patients  are  received,    b.  A  few  patients  received  free  of  charge,    c.  A  few 
patients  received  at  less  than  $io. 

260 


PAGE 

b.  Charges  not  more  than  %\o  per  week. 

1.  Arizona:    Palm  Lodge,  Tent  Colonv,  Phoenix 15 

2.  California:    Health   Camp.''  Indio 18 

3.  "            Barlow  Sanatorium/'  Los  Angeles 19 

4.  Colorado:     Emma  Booth  Tucker  Memorial  Sanatorium/' 

Amity 25 

5.  Colorado:    Agnes  Memorial  Sanatorium,  Den\er 29 

6.  "            Association  Health  Farm,  Denver 30 

7.  "            Resthaven,  Morrison 37 

8.  Connecticut:    Gaylord  Farm  Sanatorium,  Wallingford. .  .  41 

9.  Illinois:    Tent  Colony,''  Ottawa 45 

10.  Maine:    Maine  Sanatorium,  Hebron 49 

11.  Massachusetts:    State  Sanatorium,  Rutland 53 

12.  "                 Sharon  Sanatorium,  Sharon 62 

13.  Minnesota:    State  Sanatorium,  Walker ....  64 

14.  New  Jersey:    State  Sanatorium,  Glen  Gardner 68 

1 5.  New  York:    State  Hospital,  Ray  Brook 'j'j 

16.  "         "        Stony  Wold  Sanatorium,  Lake  Kushaqua.  .  .  88 

17.  "         "        Loomis  Sanatorium,  Annex,  Liberty 91 

18.  "         "         Hospital  for  Incipient  Cases,'' Rochester. ..  .  102 

19.  "         •'        Hill  Crest  and  Uplands,'' Santa  Clara 103 

20.  '■         "        Adirondack    Cottage    Sanitarium,    Saranac 

Lake 105 

21.  North   Carolina:    Franklin   Humanitarian    Home,  Black 

Mountain 113 

22.  Pennsylvania:    South  Mt.  Camp  Sanatorium.^'Mont  Alto,  119 

23.  Rhode  Island:    State  .Sanatorium,  Pascoag 131 

24.  "           "          Pine  Ridge  Camp,''  Foster 131 

25.  South  Carolina:    Aiken  Cottages,''  Aiken 135 

26.  Texas:    Camp  Reliance,  Comfort 136 

27.  Canada:    Wolfville  Highlands  Sanatorium,Wolfville,  N.  S.  140 
c.  Charges  over  $10  per  week. 

1.  Arizona:    Palm  Lodge,  Phoenix 15 

2.  California:    Mentone  Sanatorium,  Mentone 21 

3.  "             Pottenger  Sanatorium,  Monrovia 23 

4.  Colorado:    Nordrach  Ranch,  Colorado  Springs 27 

5.  "            Foxhall,  Denver 33 

6.  Connecticut:    Dr.  Brooks'  Sanatorium,  New  Canaan.  ...  39 

7.  Illinois:    St.  Ann's  Sanitarium,'^  Chicago 43 

8.  Iowa:    Boulder  Lodge  Sanatorium,  Ft.  Dodge 47 

9.  Massachusetts:    Millet  Sanatorium,  E.  Bridgewater ,  60 

10.  "                  Rutland  Cottages,  Rutland 61 

11.  Minnesota:    Luther  Hospital  Sanatorium,''  St.  Paul 65 

12.  New  Hampshire:    Pembroke  Sanatorium,  Pembroke.  ...  68 

13.  New  Mexico:    Las  Cruces  Sanatorium,  Las  Cruces 72 

14.  "          "          The  Montezuma,  Las  Vegas 75 

b,  A  few  patients  received  free  of  charge.  c.  A  few  patients  received  at  less  than  |io. 

d.  Shelter  and  fuel  free. 

261 


PAGE 

15.  New  Mexico:  St.  Joseph's  Sanatorium,  Silver  City 76 

16.  New  York:    Springside  Sanitarium,  Auburn 83 

17-      "        "         Loomis  Sanatorium,  Liberty 91 

18.  "        "         Sanatorium  Gabriels,*^  Paul  Smith's 102 

19.  "        "         Raymond  Cottage,-  Saranac  Lake 107 

20.  North  Carolina:    Winyah  Sanitarium,  Asheville 109 

21.  "            "            Dr.  Stevens' Home,  Asheville iii 

22.  "            "           Pineshire  Sanitarium,  Southern  Pines. .  113 

23.  Ohio:    Western  Hill  Hospital,'^  Price  Hill 117 

24.  Pennsylvania:    Private  Tent  Camp,  Greentown 118 

25.  "               Private  Sanatorium,  Mont  Alio 119 

26.  "               Sunnyrest,  White  Haven 129 

27.  Vermont:    Champlain  Open  Air  Sanitarium,  S.  Hero. ...  137 

28.  Wisconsin:    Evergreen   Park  Cottage  Sanatorium,  Lake 

Nebagamon 1 38 

29.  Canada:  Muskoka  Cottage  Sanatorium,  Gravenhurst,  Ont.  141 

30.  "         Lahl  Ghur,  Ste.  Agathe,  Que 145 

HL — For  advanced  cases  of  pulmonary  tuberculosis,  exclusively  or  chiefly. 

a.  Free. 

*i.  Indiana:    Flower  Mission  Pavilion,  Indianapolis 46 

2.  Massachusetts:    CuUis  Consumptives'  Home,  Boston. ...  57 

3.  New  York:    House  of  Rest,  New  York  City 97 

*4.      "         "         Montefiore  Home,  New  York  City 98 

5.  "         "         St.  Joseph's  Hospital,  New  York  City 96 

6.  Pennsylvania:    Henry   Phipps  Institute,  Hospital,  Phila- 

delphia   121 

7.  Canada;    Free  Hospital,  Toronto 145 

b.  Charges  not  more  than  $10  per  week. 

*i.  Massachusetts:    Holy  Ghost  Hospital,'' Cambridge 60 

2.  New  York:    St.  Joseph's  Hospital,  New  York  City 96 

3.  "         "         Reception  Cottage,  Saranac  Lake 107 

c.  Charges  over  Sio  per  week. 

*i.  New  York:    Home  for  Incurables;  New  York  City 97 

IV.     For  non-pulmonary  tuberculosis  in  children. 

*i.  Massachusetts:    Convalescent    Home    of   the    Children's 

Hospital,  Wellesley  Hills 63 

2.  New  York:    Seaside  Tent  Camp,  New  York  City 99 

b.  A  few  patients  received  free  of  charge,      c.  A  few  patients  received  at  j}io  per  week  or 
less. 


262 


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263 


A  HANDBOOK  ON  THE  PREVENTION  OF  TUBERCULOSI 

ISSUED  BY  THE 

Committee  on  the  Prevention  of  Tuberculosis  of  the  New  York  Charity  Organization  Socie 


CONTRIBUTORS 

A.  J.ACoBi,  M.  D.,  IIkxry  P.   Loomis,  M.  D.,  Homer  Folks, 

Hkkmann  M.  Biggs,  M.  D.,      Lilian  Brandt,  Ernst  J.  Ledkrle, 

J.  H.  HiDDLESTON,  M.  D.,       T.  Mitchell  Prudden,  M.  D.,  Ernest  Poole, 

S.  A.  Knopf,  M.  D.,  James  Alexander  Miller,  M.D.,  Charles  H.  Johnson. 


This  volume  is  a  contribution  of  the  New  York 
Charity  Organization  Society  toward  the  world-wide 
movement  to  put  an  end  to  the  most  deadly  and  most 
needless  scourge  with  which  humanity  is  afflicted.  It  is 
inspired  by  a  confident  hope  for  the  success  of  this 
movement.  The  committee  aims  to  diminish,  not  in- 
crease, the  hardships  of  those  who  are  ill;  but  it  insists 
that  it  should  be  the  duty  of  the  community  to  give  them 
a  chance  to  get  well  while  they  are  curable,  and  to  iso- 
late such  as,  through  carelessness  or  for  other  reasons, 
are  really  a  source   of  danger  to  their  fellows. 

From  the  Preface. 

The  Hatidbook  was  selected  for  the  Model  Public 
Library  exhibited  at  the  Louisiana  Purchase  Exposi- 
tion. This  library  contains  a  collection  of  some  seven 
or  eight  thousand  volumes,  comprising  in  proper  pro- 
portion the  best  books  in  every  department,  as  deter- 
mined by  the  consensus  of  a  large  number  of  librarians 
and  university  specialists. 

It  is  also  recommended  for  addition  to  libraries  in  the 
Cumulative  Book  Index  for  September,  1904,  and  the 
annual  bulletin  issued  by  the  New  York  State  Library 
includes  it  among  its  list  of  the  100  best  books  published 
in  the  United  States  in  1903. 


CLOTH,  $1.00.  PAPER,  50  Cents. 

MAIL  ORDERS  15  CENTS  ADDITIONAL 
On    sale    at    office    of   the    Charity    Organization    Society,    105    East    22d    Street,   New    York    City. 

265 


OPINIONS  OF  PHYSICIANS 

AND 

SOCIAL  WORKERS 

The  Hand  book"  I?,  a  valuable,  if  not 

Dr.  Arnold  C.     the  most  valuable",  contribution  to  the 

Klebs,  problem    of    preventing    tuberculosis. 

Chicago.  Education  in  the  prevention  of  disease, 

and    especially   in    the   prevention   of 

tuberculosis,  which  so  essentially  is  a  disease  of  the  poor 

and  ignorant,  has  to  reach  primarily  those  who  come 

incontact  with  them,  physicians,  social  workers,  teachers, 

ministers  and  nurses,  so  that  they  may  in  turn  translate 

the  truths  in  plain  and  practical  language.     For  such  a 

purpose  the  Handbook  is  admirably  suited,  and  no  one 

interested  in  public  questions  should  be  without  it. 

I  think  the  Handbook  on   the  Pre- 
Dr.  William      ventiofi  of  Tubercttlosis  will  be  of  the 
Osier,  greatest    service.      It    contains  much 

Baltimore.       material  necessary  for  use  in  the  cam- 
paign, and  as  a  work  of  reference  it 
will  be  simply  invaluable. 

The  papers    are   all   from   eminent 

Dr.  Edward  O.     sources,   presenting  with   great    per- 

Otis,  spicuity   the   various   aspects   of    the 

Boston.  tuberculosis    problem.     It    ought    to 

have  the  widest  circulation. 

This  book  is  destined  to  become  one 
Dr.A. J. Richer,  of  the  most  useful  publications  in  the 
Montreal.  anti-tuberculosis  movement.  It  should 
prove  particularly  useful  for  organiza- 
tion work,  as  it  embraces  the  whole  of  the  subject, 
treated  in  a  masterly  way  and  by  several  of  the  masters. 
A  very  commendable  feature  is  that  it  covers  practically 
every  phase  of  the  subject.  Fragmentary  literature 
upon  the  subject  of  tuberculosis  is  dangerous. 

Dr.    H.    Long=       It  is  one  of  the  most  valuable  contri- 
street  Taylor,     butions  to  the  subject  of  the  suppres- 
Saint  Paul.       sion  of  tuberculosis. 

This  book  makes  the  initiatory  step 

Dr.    William     for  civic  work  easy  and  points  out  the 

Porter,  needs,  the  methods,  and  the  results,  so 

Saint  Louis,      plainly  that  it  should  be  a  part  of  every 

family  library.     It  is  not  a  book  for  the 

physician  and  the  scientist  alone  ;  they  must  have  it  ; 

but  it  is  one  of  the  most  interesting  presentations   of 

this  important  subject  for  general  use  that  I  know  of. 

266 


Not  only  is  the  book  interesting  to 
Dr.G.W.Holden,  medical  men  as  representing  the  latest 
Denver.  ideas  on  the  prevention  of  tuberculosis 

and  the  necessity  of  organizing  socie- 
ties to  carry  out  these  ideas,  but  if  it  can  be  placed  in 
the  hands  of  the  reading  public  it  will  materially  assist 
in  demonstrating  the  need  for  the  establishing  of 
sanatoria  in  every  state  and  city.  The  public  has 
heretofore  had  very  little  information  except  meagre 
and  sensational  newspaper  articles  ;  but  in  the  publica- 
tions of  this  society  the  necessary  information  is  clearly 
and  concisely  given  by  recognized  authorities. 

The  issuing  of  this  volume  marks 

Dr.  F.  M.  Pot=    an  epoch  in  the  fight  against  tubercu- 

tenger,  losis  in  the  United  States,  and  it  is  to 

Los  Angeles,     be    hoped    that    the   book  will  be    a 

stimulus  to  others  in  this  great  work. 

Dr.  Albert  C.        The  book  contains  all  one  needs  for 
Qetchell,  a  comprehensive  and  intelligent  work- 

Worcester,       ing  knowledge  of  the  subject. 

It  is  an   able   and   scholarly   work, 
Jane  Addams,    presenting  in  a  clear  and  easily  avail- 
Hull  House,       able  manner  the  results  of  recent  in- 
Chicago.  vestigations  made   by  New  York  ex- 

perts in  medical  and  social  science. 
Those  who  have  struggled  long  for  cleaner   streets 
and  better  tenements,  for  public  baths,  small  parks  and 
playgrounds,  will  find  help  and  encouragement  in  this 
stimulating  and  interesting  record. 

Every  social  worker  who  wishes  to 

Alice  L.Higgins,  do  his  part  toward  the  cure  and  pre- 

Associated       vention  of  tuberculosis  may  learn  from 

Charities,        this  Handbook  how  to  make  his  work 

Boston.  effectual.     Those  who   own  the  book 

have  valuable  data  for  reference,  and 

all  readers  will  be  highly  rewarded,  for  the  information 

proves  of  almost  daily  use. 


PRES5  C0nnENT5 

The  Haiidbook  will  prove  of  value 
American        to  those  who  are  contemplating  similar 
Medicine.         organizations  and  also  as  a  means  of 
general    education.     The    committee, 
which  consists  of  sixteen  physicians  and  sixteen  laymen, 
is  to  be  congratulated  upon  the  work  accomplished  dur- 
ing its  first  year. 

This  Handbook  constitutes  one  of 
The  Outlook,  the  most  complete  and  thorough 
studies  of  this  terrible  disease  and  its 
prevention  that  have  been  published  in  this  country. 
It  contains  over  three  hundred  pages,  is  handsomely 
printed  and  illustrated,  includes  historical,  statistical, 
hygienic  and  pathological  papers  by  experts,  and  pre- 
sents to  the  reader  a  valuable  bibliography  and  useful 
index.     We   can    think   of    no   single    work   of    public 

267 


philanthropy  which  is  of  greater  importance  or  of  more 
widespread  public  benefit,  than  such  intelligent  efforts 
to  check  the  ravages  of  tuberculosis  as  are  typified  by 
this  Handbook  of  the  Charity  Organization  Society. 

It  approaches  the  subject,  both  from 
The  the  medical  and  the  sociological  side, 

Churchman.  with  important  illustrations  showing 
both  how  things  are  and  how  they 
ought  to  be,  gathering  together  a  multitude  of  useful 
ideas  that  have  heretofore  been  scattered  in  perishable 
leaflets  or  in  inaccessible  reports. 

Obviously  such  a  book  as  this  is  little 
New  York  suited  for  a  review  dealing  in  extracts 
Evening  Post,  or  condensations.  It  deserves  to  be 
read,  and  no  intelligent  reader  will  lay 
the  book  down  without  a  feeling  of  joy  that  the  outlook 
is  so  inspiring.  There  is  no  human  sufferer  who  needs 
more  to  hear  the  note  of  hope  than  the  consumptive, 
and  it  should  be  sounded  more  and  more  frequently  and 
with  greater  insistence.  It  ought  to  be  a  great  pleasure 
to  every  reader  to  learn  that  we  have  now  the  right  to 
sound  this  note  as  never  before. 

It  is  an  attractive  volume  of  three 
Brooklyn         hundred  and  eighty-eight  pages,  well 
Eagle.  printed  and  plentifully  illustrated,  and 

covers ,  in  papers  by  well-known  special- 
ssts,  most  of  the  phases  of  the  subject  on  which  everyone 
Jhould  be  informed.  The  names  of  Biggs,  Huddleston, 
sacobi  and  Knopf,  Loomis,  Prudden  and  Trudeau  are 
iufficient  guarantee  of  the  book's  authority  on  the  med- 
ical side,  while  de  Forest,  Devine,  Folks  and  others,  by 
their  membership  in  the  committee  or  by  contributions 
to  the  volume,  vouch  for  its  social  value. 

The  book  emphasizes  the  prime  es- 

Boston  sentials  of  proper  care,  including  right 

Transcript.      food   and   rest,    good  air,    abstention 

from    stimulants  and  tobacco,   allays 

needless  alarm  as  to  the  fear  of  contagion  from  those 

afflicted,  yet,  rightly,  insists  on  the  isolation  of  such  as 

are  really  a  source  of  danger  to  the  community. 

Besides  information  for  the  afflicted' 

Philadelphia      the  publication    shows  how  organiz" 

Record.  ations  for  fighting  consumption  may 

be   effected    and    the    problems    with 

which  they  should  deal.     It   is  to  the  multiplication  of 

anti-tuberculosis   societies   that  we  must  look   for  the 

final  eradication  of  consumption. 

This  excellent  work  should  be  in  the 
Baltimore        hands  of  every  legislator  and  public 
Sun.  official,  of  every  physician  and  head  of 

family,  being  invaluable  for  the  prac- 
tical and  sensible  guidance  which  it  affords  in  controlling 
an  ever  present  danger. 

268 


For   the  first  time   an    attempt   has 

Washington     been    made  to  supply  those   who  are 

Post.  working  to  put  an  end   "to  the  most 

deadly  and  most  needless  scourge  with 

which   humanity   is   afflicted"   with    something   in   the 

nature  of  a  text-book. 

The  Handbook  on  the  Prevention  of 
Cleveland         Tuberculosis  is   a  timely  contribution 
Leader.  to  the  literature  of  a  subject  fast  be- 

coming one  of  universal  interest. 

This  valuable  pamphlet  should  have 
Pittsburgh        wide  circulation,  not  only  in  view   of 
Telegraph.       the  need  for  more  general  knowledge 
on  the  subject  of  consumption,  but  by 
reason  of  the  fullness,  clearness  and  accuracy  of  the 
data  collected  on  its  pages.     It  is  a  comprehensive,  non- 
technical study  of  the  disease  in  relation  to  the   causes 
and  treatment. 

It  is  among  the    most    interesting 
Chicago  books  of  the  month  and  carries  com- 

Inter=Ocean.      fort  to  the  consumptive  and  to  those 
who  fear'  that  they  may  become  con- 
sumptives through  inherited  tendency. 

The  book  brings  comfort  and  hope 
San  Jose         to  the  consumptive  and  to  those  friends 
Mercury.         who  anxiously  watch  the  indications 
of  the  destructive  disease. 

Dr.  Huddleston  gives  a  clear  and 
New  Orleans  readable  description  of  the  germs  of 
Picayune,  consumption,  how  they  enter  the  body, 
what  they  do  there  and  what  natural 
protections  there  are  against  them.  Dr.  Biggs  and  Dr. 
Prudden  write  of  the  causes  of  tuberculosis  and  of  the 
methods  of  preventing  and  controlling  it,  while  Dr. 
Knopf  points  out  the  duties  of  different  classes  of  the 
community  and  of  the  government  in  combating  this 
dread  disease.  The  forms  which  tuberculosis  assumes 
when  it  attacks  children  and  the  ways  of  safeguarding 
them  from  it,  are  treated  by  Dr.  Jacobi.  Dr.  Loomis 
describes  modern  sanatorium  treatment  and  discusses 
the  question  of  climate.  A  valuable  contribution  on  a 
much  neglected  means  for  fightmg  consumption  is  made 
by  Dr.  Miller  in  his  article  on  the  management  of  such 
cases  in  the  dispensary. 


-260 


CtiARITlES 


A  BROAD  FIELD  A  SHORT  NAME 

A  PRACTICAL  VIEWPOINT 

Charities  is  a  weekly  journal,  a  monthly  review,  of  things 
charitable  and  social 


In  its  capacity  as  a  weekly  newspaper  Charities  reports  and  dis- 
cusses new  movements  and  legislation. 

In  its  monthly  magazine  it  continues  the  weekly  news  service  with 
fifty  or  more  additional  pages  of  thorough,  suggestive  matter  on  the 
general  trend  of  affairs,  conspicuous  movements  and  things  accomplished 
— a  fully  illustrated  monthly  magazine. 

The  current  events — men,  measures,  methods — of  the  movement 
for  the  Prevention  of  Tuberculosis  are  chronicled  every  week  in  brief, 
labor-saving  but  comprehensive  form.  Once  or  more  monthly,  longer 
articles  are  published,  treating  specific  phases  of  the  problems  presented 
by  tuberculosis  in  different  states  and  cities,  invariably  written  from  first- 
hand information. 

Some  Recent  Articles  in  Charities. 

A  French  Society  for^  the  Protection  of  Children  Against 
Tuberculosis. 

The  Tuberculosis  Exposition  at  Baltimore.  Marshall  Lang- 
ton  Price,  M.  D. 

The  Handbook  on  the  Prevention  of  Tuberculosis.  Reviewed 
by  Arnold  C.  Klebs,  M.  D. 

Tuberculosis  and  the  Italians  of  the  United  States.  Antonio 
Stella,  M.  D. 

To  Fight  Tuberculosis  on  National  Lines— Organization  of 
the  National  Association  for  the  Study  and  Prevention  of 
Tuberculosis. 

Dispensaries  for  Tuberculosis.    Edward  O.  Otis,  M.  D. 

A  Seaside  Tent  Camp  for  the  Treatment  of  TulDerculosis  in 
Children.    Lmsly  R.  "Williams,  M.  D. 

The  Spirit  of  a  Sanatorium.    Christopher  C.  Easton. 

A  Simple  Sanatory  Tent.     Henry  L.  Ulrich,  M.  D. 

A  Roster  of  the  Anti-Tuberculosis  Campaign. 

Mountain  View  Farm.     Rev.  Robert  P.  Kreitler. 

The  Reception  Hospital  at  Saranac  Lake. 

The  Prevention  and  Treatment  of  Tuberculosis  in  Penal 
Institutions.    J.  B.  Ransom,  M.  D. 

"Lean-To's"  at  the  Loomis  Sanatorium,  Liberty,  N.  Y. 
Herbert  Maxon  King,  M.  D. 

EDWARD  T.  DEVINE,         .         _         _         -         Editor. 

Published  at  105  East  2  2d  Street  by  the  Charity  Organization 
Society  of  the  City  of  New  York. 

Subscription  price,  $2  yearly.  Single  copies,  10  cents.  Special 
trial  rate  to  new  readers,  8  months;  33  issues,  $1. 

270 
[O  4.352] 


DUE  DATE                                : 

' 

Printed 
in  USA 

COLUMBIA  UNIVERSITY  LIBRARIES 


L_        60223188 


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